Aa
Low Platelets
Hello,
I was diagnosed with end stage cirrhosis back in March 2010. My last lab test revealed my platelet count is down to 60k. I have concerns since I read I could be heading for real trouble at around 20k. I have splenomegaly (enlarged spleen) which I think is directly responsible for the low platelet count. Any suggestions I would sure appreciate.
Thx
Randy
I was diagnosed with end stage cirrhosis back in March 2010. My last lab test revealed my platelet count is down to 60k. I have concerns since I read I could be heading for real trouble at around 20k. I have splenomegaly (enlarged spleen) which I think is directly responsible for the low platelet count. Any suggestions I would sure appreciate.
Thx
Randy
COMMUNITY LEADER
Wow Hector you sure have a wealth of information and I appreciate your help and concerns.
Here is what I know about vitamin C:
vitamin C is a powerful antioxidant and high doses of it may prevent free-radical mediated damage of the platelets.
It's not that vitamin C will increase platelets it protects them from being destroyed by free-radicals. As you stated vitamin C is known to promote the absorbtion of iron but even as a cirrhotic patient we need to maintain a healthy level. We can monitor this level with lab testing. Mine is a 68 with a normal range of 45-170. There are certainitly pros and cons to using this vitamin and should be only used if approved by your gastro or hepatologist. In my case, having grade III varicies and a high risk of bleeding from low platelets, the Vitamin C I take has much more benefit than any risk of absorbing more iron. Afterall, your body can only absorb the iron you put into it. I try to maintain a health level of iron in my diet through food only and I don’t allow any through pills. This has been working great so far, no bleeding and my iron is in range and towards the lower side.
I really like your explaination of the METAVIR system. It will certainly clear up any confusion with diagnosis.
My diagnosis made with a CT scan clearly reveals cirrhosis. My treatment has been based on lab results and imagining. An invasive procedure (biopsy) seemed like an un-necessary risk. A patient with cirrhosis already has a compromised immmune system. I don't see how a biopsy would have changed my treatment options at this point. I must apologize for not having a better understanding of hepatitis induced cirrhosis vs. alcoholic cirrhosis. Since I wasn’t facing an any underlying diseases I didn’t need a biopsy. It was clear as day why I got cirrhosis and that it was severe enough to give me a certain level of treatment. Progression or not my lab testing and symptoms will tell me if I need a transplant. It is after all, the testing (blood work) that’s used to generate a MELD. I could have a biopsy tell me that I’m getting worse but until my MELD gets to the right point they won’t give me a new liver. I think reasons for biopsy fall to the side under my circumstances.
I recently move from El Paso where I have been receiving treatment from a gastroenterologist. They were no Hematologists available but that is not the case here in Nashville. So I am excited to be able to get another professional opinion and perhaps better treatment options.
Thank you again Hector!
Randy
Here is what I know about vitamin C:
vitamin C is a powerful antioxidant and high doses of it may prevent free-radical mediated damage of the platelets.
It's not that vitamin C will increase platelets it protects them from being destroyed by free-radicals. As you stated vitamin C is known to promote the absorbtion of iron but even as a cirrhotic patient we need to maintain a healthy level. We can monitor this level with lab testing. Mine is a 68 with a normal range of 45-170. There are certainitly pros and cons to using this vitamin and should be only used if approved by your gastro or hepatologist. In my case, having grade III varicies and a high risk of bleeding from low platelets, the Vitamin C I take has much more benefit than any risk of absorbing more iron. Afterall, your body can only absorb the iron you put into it. I try to maintain a health level of iron in my diet through food only and I don’t allow any through pills. This has been working great so far, no bleeding and my iron is in range and towards the lower side.
I really like your explaination of the METAVIR system. It will certainly clear up any confusion with diagnosis.
My diagnosis made with a CT scan clearly reveals cirrhosis. My treatment has been based on lab results and imagining. An invasive procedure (biopsy) seemed like an un-necessary risk. A patient with cirrhosis already has a compromised immmune system. I don't see how a biopsy would have changed my treatment options at this point. I must apologize for not having a better understanding of hepatitis induced cirrhosis vs. alcoholic cirrhosis. Since I wasn’t facing an any underlying diseases I didn’t need a biopsy. It was clear as day why I got cirrhosis and that it was severe enough to give me a certain level of treatment. Progression or not my lab testing and symptoms will tell me if I need a transplant. It is after all, the testing (blood work) that’s used to generate a MELD. I could have a biopsy tell me that I’m getting worse but until my MELD gets to the right point they won’t give me a new liver. I think reasons for biopsy fall to the side under my circumstances.
I recently move from El Paso where I have been receiving treatment from a gastroenterologist. They were no Hematologists available but that is not the case here in Nashville. So I am excited to be able to get another professional opinion and perhaps better treatment options.
Thank you again Hector!
Randy
Hector makes a good point about iron. People with cirrhosis need to be careful to avoid iron. A good multi-vitamin without was recommended to me.
I found a food based one.
If you are going to take supplements, be sure to read the labels. Since our livers filter everything, some supplements are harder on us than others, simply because of the casing of the capsule. I used a vitamin D, which I could put on my skin, and was absorbed that way. Speaking of which, cirrhotics often have low vitamin D. You should get yours checked.
And do check the iron content of your vitamin C.
I'm assuming you meant there were good hepatologists, liver doctors in Nashville.
My understanding is cirrhosis doesn't differ whether its caused from alcohol of hepatitis. Hector can correct me on this, if I'm mistaken.
BTW: I never had a biopsy until after I had my transplant. The reason why is we already knew I had decompensated cirrhosis due to my ascites.
I found a food based one.
If you are going to take supplements, be sure to read the labels. Since our livers filter everything, some supplements are harder on us than others, simply because of the casing of the capsule. I used a vitamin D, which I could put on my skin, and was absorbed that way. Speaking of which, cirrhotics often have low vitamin D. You should get yours checked.
And do check the iron content of your vitamin C.
I'm assuming you meant there were good hepatologists, liver doctors in Nashville.
My understanding is cirrhosis doesn't differ whether its caused from alcohol of hepatitis. Hector can correct me on this, if I'm mistaken.
BTW: I never had a biopsy until after I had my transplant. The reason why is we already knew I had decompensated cirrhosis due to my ascites.
COMMUNITY LEADER
That my friend is some very good research. Thank you for all the time and effort you put in to that. I am currently using a beta blocker (Metoprolol) and it is keeping my blood pressure right around 105/58. I try to watch lifting heavy but you know how that can go.
I still have hopes of avoiding transplant but I know I need to be prepared just in case. I am actually here in Nashville only about 2 1/2 to 3 hours from Memphis which might give me an advantage someday. Vanderbilt is the transplant center here and I'll see my new general doctor the first part of July. It was recommended to me from two doctors I see a Gastro and Hepatologist here. My last gastro doc started telling me a year ago that approx. 5 years I will need a transplant but it’s been my goal to make him wrong.
So I just keep doing what’s been working for me. It’s good to hear from others and get their take on things that sometimes are easily forgotten, overlooked or simply just not known. I think our group is well on it’s way!
Thank you again for your very informative posting!
Randy
I still have hopes of avoiding transplant but I know I need to be prepared just in case. I am actually here in Nashville only about 2 1/2 to 3 hours from Memphis which might give me an advantage someday. Vanderbilt is the transplant center here and I'll see my new general doctor the first part of July. It was recommended to me from two doctors I see a Gastro and Hepatologist here. My last gastro doc started telling me a year ago that approx. 5 years I will need a transplant but it’s been my goal to make him wrong.
So I just keep doing what’s been working for me. It’s good to hear from others and get their take on things that sometimes are easily forgotten, overlooked or simply just not known. I think our group is well on it’s way!
Thank you again for your very informative posting!
Randy
COMMUNITY LEADER
Vanderbilt sounds good. I am glad to hear you will connecting up with them soon.
I see you understand about beta blockers and lifting heavy weights. I use light dumbells and that seems to work for me as I want to be in shape when I have my transplant. The better for bouncing back after transplant surgery.
I am glad you are on top of this and being monitored. It has been a pleasure hearing about how you have been managing your liver disease, Randy. I wish everyone was as open and learning through their experience as you are. With your attitude I am sure things will look out for you. Attitude is so very important as we face the challenges of this disease. We can't control what our disease will do but we can choose how we interrupt it use it to help us carry on despite some scary things that can happen with this disease.
Be well.
Cheers!
Hector
I see you understand about beta blockers and lifting heavy weights. I use light dumbells and that seems to work for me as I want to be in shape when I have my transplant. The better for bouncing back after transplant surgery.
I am glad you are on top of this and being monitored. It has been a pleasure hearing about how you have been managing your liver disease, Randy. I wish everyone was as open and learning through their experience as you are. With your attitude I am sure things will look out for you. Attitude is so very important as we face the challenges of this disease. We can't control what our disease will do but we can choose how we interrupt it use it to help us carry on despite some scary things that can happen with this disease.
Be well.
Cheers!
Hector
COMMUNITY LEADER
I felt this might be an interesting addition to this thread:
http://tinyurl.com/c6ywn6e
"Alcoholic Liver Disease May Not Lead to Cancer"
Patients with alcoholic cirrhosis have a lower risk of liver cancer than previously thought, Danish researchers found.
In a Danish registry study, 5-year risk of hepatocellular carcinoma among these patients was only 1%, Peter Jepsen, MD, PhD, of Aarhus University Hospital, and colleagues reported in the June 19 issue of the Annals of Internal Medicine.
And liver cancer contributed little to the high mortality seen in this population overall, as only 1.8% of deaths were related to the carcinoma, they found.
As a result, "hepatocellular carcinoma surveillance would be expected to have a minimal effect on mortality and is unlikely to be cost-effective," they wrote.
Patients with alcoholic cirrhosis are at higher risk for hepatocellular carcinoma than the general population, but the utility of liver cancer surveillance for these patients is unclear.
Jepsen and colleagues looked at data from a national registry on hepatocellular carcinoma among 8,482 Danish patients who'd been diagnosed with alcoholic cirrhosis between 1993 and 2005. Median follow-up was 4.1 years.
Over the study period, 169 patients developed hepatocellular carcinoma.
The researchers found that cumulative risk of the cancer increased steadily with time since the cirrhosis diagnosis, and was 1% at 5 years (95% CI 0.8% to 1.3%).
In sensitivity analyses that included all possible hepatocellular carcinoma diagnoses and a subpopulation of patients who were followed by hepatologists, the highest 5-year cancer risk was not much higher, at only 1.9%.
Cancer incidence was markedly higher for men than for women, they reported, and it rose with age.
Most of the patients who developed the cancer died (151 of 169), and 83.5% of these deaths were related to the cancer. The median survival time from diagnosis was 97 days for localized disease and 37 days for metastatic disease.
Overall mortality was high in the cohort, with 67.6% of patients dying during the study period.
In an assessment of cause-specific mortality through Jan. 1, 2009, the cumulative 5-year total mortality was 43.5%, while the 5-year risk for hepatocellular carcinoma death was only 0.8%, the researchers reported.
Thus, only 1.8% of all deaths were liver cancer-related -- a proportion that didn't change noticeably over time, they wrote.
"Hepatocellular carcinoma contributes little to their high mortality," Jepsen and colleagues wrote, noting that the results suggest cirrhosis patients would benefit only marginally from routine liver cancer surveillance, which falls below the country's accepted threshold for cost-effectiveness anyway.
They noted that the study was limited because diagnoses of cirrhosis and hepatocellular carcinoma were made by hospital physicians without uniform clinical criteria, and because the registry data lacked detailed information on patient care.
The journal listed the primary funding source as "none."
The researchers reported no conflicts of interest.
http://tinyurl.com/c6ywn6e
"Alcoholic Liver Disease May Not Lead to Cancer"
Patients with alcoholic cirrhosis have a lower risk of liver cancer than previously thought, Danish researchers found.
In a Danish registry study, 5-year risk of hepatocellular carcinoma among these patients was only 1%, Peter Jepsen, MD, PhD, of Aarhus University Hospital, and colleagues reported in the June 19 issue of the Annals of Internal Medicine.
And liver cancer contributed little to the high mortality seen in this population overall, as only 1.8% of deaths were related to the carcinoma, they found.
As a result, "hepatocellular carcinoma surveillance would be expected to have a minimal effect on mortality and is unlikely to be cost-effective," they wrote.
Patients with alcoholic cirrhosis are at higher risk for hepatocellular carcinoma than the general population, but the utility of liver cancer surveillance for these patients is unclear.
Jepsen and colleagues looked at data from a national registry on hepatocellular carcinoma among 8,482 Danish patients who'd been diagnosed with alcoholic cirrhosis between 1993 and 2005. Median follow-up was 4.1 years.
Over the study period, 169 patients developed hepatocellular carcinoma.
The researchers found that cumulative risk of the cancer increased steadily with time since the cirrhosis diagnosis, and was 1% at 5 years (95% CI 0.8% to 1.3%).
In sensitivity analyses that included all possible hepatocellular carcinoma diagnoses and a subpopulation of patients who were followed by hepatologists, the highest 5-year cancer risk was not much higher, at only 1.9%.
Cancer incidence was markedly higher for men than for women, they reported, and it rose with age.
Most of the patients who developed the cancer died (151 of 169), and 83.5% of these deaths were related to the cancer. The median survival time from diagnosis was 97 days for localized disease and 37 days for metastatic disease.
Overall mortality was high in the cohort, with 67.6% of patients dying during the study period.
In an assessment of cause-specific mortality through Jan. 1, 2009, the cumulative 5-year total mortality was 43.5%, while the 5-year risk for hepatocellular carcinoma death was only 0.8%, the researchers reported.
Thus, only 1.8% of all deaths were liver cancer-related -- a proportion that didn't change noticeably over time, they wrote.
"Hepatocellular carcinoma contributes little to their high mortality," Jepsen and colleagues wrote, noting that the results suggest cirrhosis patients would benefit only marginally from routine liver cancer surveillance, which falls below the country's accepted threshold for cost-effectiveness anyway.
They noted that the study was limited because diagnoses of cirrhosis and hepatocellular carcinoma were made by hospital physicians without uniform clinical criteria, and because the registry data lacked detailed information on patient care.
The journal listed the primary funding source as "none."
The researchers reported no conflicts of interest.
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A list of national and international resources and hotlines to help connect you to needed health and medical services.
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Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
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PrEP is used by people with high risk to prevent HIV infection.
I wanted to mention the standard treatment to prevent variceal bleeding.
All quotes are from the AASLD Practice Guideline for for managing Varices.
'Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis'
http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Prevention%20and%20Management%20of%20Gastro%20Varices%20and%20Hemorrhage.pdf
Recommendations
8. In patients with medium/large varices that have not bled but have a high risk of hemorrhage (Child B/C or variceal red wale markings on endoscopy),
nonselective -blockers (propranolol or nadolol) or EVL may be recommended for the prevention of first variceal hemorrhage (Class I, Level A).
9. In patients with medium/large varices that have not bled and are not at the highest risk of hemorrhage (Child A patients and no red signs), nonselective -blockers (propranolol, nadolol) are preferred and EVL (banding) should be considered in patients with contraindications or intolerance or non-compliance to -blockers (Class I, Level A).
10. If a patient is placed on a nonselective -blocker, it should be adjusted to the maximal tolerated dose; follow-up surveillance EGD is unnecessary. If a patient is treated with EVL, it should be repeated every 1-2 weeks until obliteration with the first surveillance EGD performed 1-3 months after
obliteration and then every 6-12 months to check for variceal recurrence (Class I, Level C).
11. Nitrates (either alone or in combination with -blockers), shunt therapy, or sclerotherapy should not be used in the primary prophylaxis of variceal
hemorrhage (Class III, Level A).
What this is saying is that all patients with varices should be taking a beta-blocker to prevent the first bleed. It reduces the portal hypertension that we with scared livers have. Why is this important and basic treatment for all cirrhotics? Because once we bleed the chances of future bleeds goes way up. All pretransplant patients that I know use them. I have been taking Nadolol for 3-4 years now and have no bleeds. It is the only proven way to prevent bleeds other than banding which is the next thing to be done before bleeding. Bleeding from varices is a potentially life-threatening complication of cirrhosis. You can actually lose most of the body's blood during a bleed.
'Patients who survive an episode of acute variceal hemorrhage have a very high risk of rebleeding and death. The median rebleeding rate in untreated individuals is around 60% within 1-2 years of the index hemorrhage, with a
mortality of 33%.'
'Nonselective -blockers have no role in the prevention of the development of esophagogastric varices but are the gold standard in the prevention of first variceal hemorrhage in patients with medium/large varices. Endoscopic variceal ligation (banding) has been established as an alternative to nonselective -blockers for the prevention of initial variceal hemorrhage.'
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I am glad you are in Memphis where you will be able to see a hepatologist.
Methodist is where Steve Jobs had his liver transplant.
Maybe you can get a referral from your current doctor to have the transplant center do an evaluation so you know what options are available to you.
Methodist University Hospital Transplant Institute
1265 Union Ave.
Memphis, TN 38104
http://www.methodisthealth.org/healthcare-services/transplant-institute/organ-transplant-outpatient-clinic/
Transplant Outpatient Clinic
Pre-Transplant Evaluation
A good candidate for a transplant is determined by a full medical evaluation and input from several medical professionals. The transplant team performs this evaluation in the Pre-Clinic. This team is composed of the transplant surgeon, hepatologist/nephrologist, pre-coordinator nurse, financial case manager, and social worker.
Evaluation Process
The evaluation process begins with a referral from a potential candidate's primary care physician. The candidate then answers a variety of health and lifestyle questions. This information helps the transplant team decide the eligibility of the transplant candidate.
During an initial visit, a transplant candidate will meet with a financial coordinator and a social worker and receive detailed information about the transplant process. For those who are identified as potential candidates, a complete medical evaluation is performed. The medical evaluation is a series of tests dependent upon the specifics of each case. The surgeon reviews the results of this medical examination to further determine eligibility. If the evaluation indicates the candidate is appropriate for transplantation, staff members work with the patient to finalize financial arrangements.
The candidate will receive written confirmation and be listed with the United Network for Organ Sharing (UNOS), a non-profit scientific and educational organization that administers the only national patient waiting list. Once listed with UNOS, patient evaluations must be performed at regular intervals to determine continual eligibility for transplantation. Should an organ become available, it is offered to a patient on the list based on a defined set of criteria established by UNOS.
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Local Support Group
Get the support you need with Living Kindly, monthly support group sponsored by Methodist Healthcare. The group is open to caregivers, family members, transplant candidates, donors and those who have had a transplant. You will have access to knowledgeable speakers discussing a variety of subjects, such as medication side effects, living donation, financial concerns, blood donation and maintaining a healthy lifestyle.
Methodist University Hospital Transplant Institute staff is on hand at each meeting to offer support, share their knowledge and answer any questions you might have. More importantly, other transplant donors and recipients are available to share their transplant experiences or provide mutual peer support to you and your family.
Not a joiner? That's okay. You are welcome to attend and listen. Living Kindly is designed to give donors and recipients access to as much information as possible to assist with their transplantation journey.
The group currently meets the second Thursday of each month in Stratton Auditorium, which is located at Methodist University Hospital (1265 Union Avenue). The class starts at 3:30 p.m., with a medication education session beginning at 3 p.m.
Food and beverages are served and parking is free.
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I would highly recommend you meet others who are waiting for transplants. It is a good way to learn a lot and you will see that many others are going through what you are going through.
Cheers!
Hector