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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
New lab results taken 07/10/12 show a 20 point increase bringing my platelet count to 80k from the 60k I was tested at on 03/28/10! I know this can change quickly in my next lab test yet still nice to see the difference I can make with diet.
My new doctor has sent the required information for evaluation by Vanderbilt transplant center. It's weird.. I hope to be accepted for reason of possibly better medical treatment and guidance yet I also hope not to be bad enough to be accepted.
I hope everything is going well on your end, Keep taking care!
Randy
My new doctor has sent the required information for evaluation by Vanderbilt transplant center. It's weird.. I hope to be accepted for reason of possibly better medical treatment and guidance yet I also hope not to be bad enough to be accepted.
I hope everything is going well on your end, Keep taking care!
Randy
COMMUNITY LEADER
Since this is a forum for all people with cirrhosis regardless the cause of their liver disease, it seems impudent to promote the use of Vitamin C (IV in particular) when a person with cirrhosis due to Hemochromatosis can be injured by its use.
What Is Hemochromatosis?
Hemochromatosis occurs when the body absorbs too much iron from foods (and other sources such as vitamins containing iron). This disease causes extra iron to gradually build up in the body's tissues and organs, a term called iron overload. If this iron buildup is untreated, it can, over many years, damage the body's organs.
Tips for Living Well with Hemochromatosis
There is much you can do to make sure your life is as normal and healthy as possible.
Check-ups: Have the amount of iron in your blood checked regularly.
Phlebotomy: Make sure to get phlebotomies when you need them.
Phlebotomy is the best treatment for hemochromatosis. Hemochromatosis cannot be treated by changing your diet alone.
Iron pills: Don't take iron pills, supplements, or multivitamin supplements that have iron in them. Eating foods that contain iron is fine.
Vitamin C: Vitamin C increases the amount of iron your body absorbs. Avoid taking pills with more than 500 mg of vitamin C per day. Eating foods with vitamin C (such as oranges) is fine.
http://www.cdc.gov/Features/Hemochromatosis/
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Raising a person platelet count has no advantage for most cirrhotic patients. It doesn't improve their illness in any way. Besides platelet counts vary all the time as do all blood levels. The only time platelet count is a problem is when it goes lower than 20,000. Platelet count is caused by cirrhosis. Unless the cirrhosis is eliminated, platelet counts will always be below normal values.
Why cirrhotics have low platelet counts -
Blood flows from the spleen...through the portal vein...then through the liver.
Scar tissue in the liver (cirrhosis) can interfere with that blood flow, causing pressure to build up in the portal vein (portal hypertension), and the spleen to enlarge (splenomegaly).
As the spleen enlarges, it traps platelets. (The amount of platelets in the bloodstream is reduced because the spleen is busy trapping them).
So usually---people with cirrhosis end up having a problem with portal hypertension and an enlarged spleen, and a reduced platelet count in the bloodstream. As time goes by, the liver may try to repair itself by growing new cells. If there is a lot of scar tissue already present--- the new cells grow between scar tissue (and result in abnormal nodules). (The nodules and scar tissue can further interfere with blood flow through the liver). So over time people with advanced cirrhosis can end up having a problem with more and more abnormal nodules and scar tissue forming...which interferes even more with blood flow through the liver.....which makes the spleen continue to enlarge....and the platelet count continue to drop.
Hector
What Is Hemochromatosis?
Hemochromatosis occurs when the body absorbs too much iron from foods (and other sources such as vitamins containing iron). This disease causes extra iron to gradually build up in the body's tissues and organs, a term called iron overload. If this iron buildup is untreated, it can, over many years, damage the body's organs.
Tips for Living Well with Hemochromatosis
There is much you can do to make sure your life is as normal and healthy as possible.
Check-ups: Have the amount of iron in your blood checked regularly.
Phlebotomy: Make sure to get phlebotomies when you need them.
Phlebotomy is the best treatment for hemochromatosis. Hemochromatosis cannot be treated by changing your diet alone.
Iron pills: Don't take iron pills, supplements, or multivitamin supplements that have iron in them. Eating foods that contain iron is fine.
Vitamin C: Vitamin C increases the amount of iron your body absorbs. Avoid taking pills with more than 500 mg of vitamin C per day. Eating foods with vitamin C (such as oranges) is fine.
http://www.cdc.gov/Features/Hemochromatosis/
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Raising a person platelet count has no advantage for most cirrhotic patients. It doesn't improve their illness in any way. Besides platelet counts vary all the time as do all blood levels. The only time platelet count is a problem is when it goes lower than 20,000. Platelet count is caused by cirrhosis. Unless the cirrhosis is eliminated, platelet counts will always be below normal values.
Why cirrhotics have low platelet counts -
Blood flows from the spleen...through the portal vein...then through the liver.
Scar tissue in the liver (cirrhosis) can interfere with that blood flow, causing pressure to build up in the portal vein (portal hypertension), and the spleen to enlarge (splenomegaly).
As the spleen enlarges, it traps platelets. (The amount of platelets in the bloodstream is reduced because the spleen is busy trapping them).
So usually---people with cirrhosis end up having a problem with portal hypertension and an enlarged spleen, and a reduced platelet count in the bloodstream. As time goes by, the liver may try to repair itself by growing new cells. If there is a lot of scar tissue already present--- the new cells grow between scar tissue (and result in abnormal nodules). (The nodules and scar tissue can further interfere with blood flow through the liver). So over time people with advanced cirrhosis can end up having a problem with more and more abnormal nodules and scar tissue forming...which interferes even more with blood flow through the liver.....which makes the spleen continue to enlarge....and the platelet count continue to drop.
Hector
Glad for the new forum. I've been a little lost dealing with bleedout and bandings since I finished triple. My platelets have not gotten above 70 since pre tx. Hopefully liver is regenerating and spleen will calm down and quit hoarding. haha!
Karen :)
Karen :)
COMMUNITY LEADER
Thank you Diana and welcome to our new group!
Vitamin C surely isn't for everyone with cirrhosis but in my personal circumstance I think it fits pretty well. I didn't know that about garlic so I did some looking around and found this little artice:
Garlic, a pungent spice used to enliven many food dishes, has a long history of medicinal use to treat everything from the common cold to cancer. Garlic may also play a part in protecting against heart disease by its effect on platelets, irregularly shaped cell fragments that are the smallest of the blood cells, according to the University of Oklahoma Health Sciences Center. Platelets clump together at the site of injury to help stop bleeding. Taking garlic doesn't produce more platelets, but it does decrease platelet aggregation, the ability to stick together.
Read more: http://www.livestrong.com/article/528281-does-garlic-help-raise-platelet-count/#ixzz1zC88jLbN
Thank you for passing along the info, diet plays a huge role in our recovery so everything ingested should be carefully considered.
Vitamin C surely isn't for everyone with cirrhosis but in my personal circumstance I think it fits pretty well. I didn't know that about garlic so I did some looking around and found this little artice:
Garlic, a pungent spice used to enliven many food dishes, has a long history of medicinal use to treat everything from the common cold to cancer. Garlic may also play a part in protecting against heart disease by its effect on platelets, irregularly shaped cell fragments that are the smallest of the blood cells, according to the University of Oklahoma Health Sciences Center. Platelets clump together at the site of injury to help stop bleeding. Taking garlic doesn't produce more platelets, but it does decrease platelet aggregation, the ability to stick together.
Read more: http://www.livestrong.com/article/528281-does-garlic-help-raise-platelet-count/#ixzz1zC88jLbN
Thank you for passing along the info, diet plays a huge role in our recovery so everything ingested should be carefully considered.
I have been told ( I have not tried it yet) that Clorophyll will help raising platelets levels.
Also avoid garlic as it will increase the bleeding time
Personaly I can vouch for vit C, my platelets levels incresed during IV vit C, 30g/week in one infusion
I hope this helps
Also avoid garlic as it will increase the bleeding time
Personaly I can vouch for vit C, my platelets levels incresed during IV vit C, 30g/week in one infusion
I hope this helps
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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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