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Low platelets

Hi everyone.. It's 6 months post treatment, but platelets are lower than month ago. They were 64, now 59..can it because virus is back? If anyone Has experience, please tell me... Thanks
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683231 tn?1467323017
Did you do any testing for yourself yet?

One thing is even if he is cured of hep C he still needs to be followed closely by his doctor because he has liver cirrhosis. I get blood tests every 6 months and an abdominal ultrasound because I am still at an increased risk of liver cancer because I have cirrhosis. I have an upper endoscopy every two years because I previously had esophageal varicies. I see my liver specialist every year. I also have to get my flu vaccine every year because we with cirrhosis are at an increased risk of complications from illnesses because we have a chronic serious medical condition. When I learned I have cirrhosis I was vaccinated against Hepatitis A and B as I cannot afford to contract another form of hepatitis. I also was vaccinated against pneumonia a vaccination normally given to those over 65 which I was given at 50 years old.

Even though we are cured of hep c we still have a chronic serious medical condition and need to still be under a doctors care.
Helpful - 0
Hi Fllyin! I haven't noticed new message from you till now.. sorry I didn't respond
No, I haven't done test for me, but in Monday I will have some lab tests, so there will be Alt and Ast, bilirubin, and so I Will see if something is going on. My husband got his lab tests few days ago and they are not good. Ast 81, Alt 99, platelets 45...His final test for HepC, after 6 months treatment will be done soon, but he told me that he has bad feeling about it...I told him, I believe that everything will be okay, but I am not sure... feel very sad and worried...all that struggle, hoping and money for that therapy.. don't know if he will be able to make that again...
Not everyone with hep c will have elevated liver enzymes. To be sure you are not infected you should have the hep c antibody test. I doubt you are but to know for sure you should have the antibody test then if that is positive have the HCV RNA by PCR test to check for the virus.

Were his liver enzymes ever normal during treatment? Has he had the HCV RNA test done after he finished treatment? If he had the HCV RNA test done at least 12 weeks after finishing treatment and it was not detected  his odds are very good like 99.8% chance he is cured and will always test not detected for hep c.

He has cirrhosis which is indicated by his very low platelet count which also means he very likely has portal hypertension which is higher that normal blood pressure in the main vein inside the liver. This high pressure will not show on a regular blood pressure test using a cuff over the arm.

Portal hypertension can cause the development of esophageal varicies which are enlarged blood vessels in the throat. Has he had a test called an upper endoscopy to check for this? I had enlarged varicies and had to have them banded to prevent a dangerous bleed. My platelets before treatment were around 85 but have risen now to about 125 just a little below normal.

I hoping his HCV RNA test shows not detected and he is cured of hep c.

Best to you both
Test after 12 week was good and Alt and Ast ok..now high...Thanks again and I hope and pray...
Yeah it would be unusual to relapse after testing undetected at 12 weeks post but having his liver enzymes return to above normal is concerning. When I learned I had relapsed after treating with Sovaldi and Olysio it was on my 12 week post treatment HCV RNA test. I had been tested for liver enzymes as well and received those results before the HCV RNA results. My enzymes that had been normal during  treatment had risen just slightly above normal which I guessed might mean I had relapsed and I guessed correctly.

Hopefully his elevated liver enzymes are not due to relapse but to some other cause.

Wishing you both good luck
Yeah..I told him that it could be because his  gallstones, to comfort him and maybe because we eat some meat recently ( he is vegan for years)for rising platelets...but I am afraid he relapsed for the third time and he will not be able too take another therapy again...I was praying God for miracle. Thanks again for your time and help Fllyin!
I treated 3 times with interferon based meds before the new meds became available. My first try with the new generation DAA’s Sovaldi and Olysio ended in relapse. I was finally cured on my 5th treatment with Harvoni and ribavirin for 24 weeks. So if he has relapsed just keep trying never give up there is a cure out there for him.

From the Mayo Clinic

“ Over-the-counter pain medications, particularly acetaminophen (Tylenol, others)
Certain prescription medications, including statin drugs used to control cholesterol
Drinking alcohol
Heart failure
Hepatitis A
Hepatitis B
Hepatitis C
Nonalcoholic fatty liver disease
Other causes of elevated liver enzymes may include:

Alcoholic hepatitis (severe liver inflammation caused by excessive alcohol consumption)
Autoimmune hepatitis (liver inflammation caused by an autoimmune disorder)
Celiac disease (small intestine damage caused by gluten)
Cytomegalovirus (CMV) infection
Epstein-Barr virus
Hemochromatosis (too much iron stored in your body)
Liver cancer
Polymyositis (inflammatory disease that causes muscle weakness)
Sepsis (an overwhelming bloodstream infection that uses up neutrophils faster than they can be produced)
Thyroid disorders
Toxic hepatitis (liver inflammation caused by drugs or toxins)
Wilson's disease (too much copper stored in your body)”
Well..non of these above. Maybe gluten:( few times.. He tried so hard to live healthy. Thanks again, we'll stay in touch!
is he overweight at all? Probably not with his diet but having extra weight can contribute to fatty liver which can cause elevation in liver enzymes. And just having cirrhosis may also cause his elevated liver enzymes. Hoping for you both it’s not a relapse and just a sign of what is already known that he has cirrhosis.
No, he is very tiny, skinny.. don't eat Oil, sugar, at all. He will know pcr result on Monday...
Pcr negative! I am so happy!!! He must do some abdomen ultrasound on Wednesday and have another blood test because high enzymes..but virus is gone, forever I hope! Thanks Fllyin, for your help and support!!! We'll stay in touch!
That is fantastic news so happy for you both. If the virus has been not detected for this long it will not be back! I know after so long fighting it’s hard to believe but he is finally free of Hepatitis c so now the question is what is causing the elevated liver enzymes but one day at a time.

For now enjoy your victory!

Congrats and thanks for letting me know :-)
Thanks again for your help and support! It was very helpful..Yes, it's hard to believe that virus has finally gone. Every day I remind myself that God has allowed us to win, and feel grateful. Abdomen ultrasound was good too..
All the best for you and take care Fllyin!!
Hi again..We celebrated our win and was happy couple of days but sinse last Sunday, he is complaining on permanent pain in liver area. Is it usual in liver cirrhosis patients? He will sing on his concert tonight, despite this constant pain... how dangerous is it? What to do?
The liver itself has no nerves to sense pain. However, every internal organ is surrounded by a membrane which does have pain receptor nerves. When the liver is enlarged it can put against this membrane and cause pain sensations. My only suggestion is to discuss safe pain relievers with his liver specialist. But my understanding is patients with cirrhosis should avoid over the counter pain meds in the NDAID family like Advil, Aleve and aspirin as well as all those meds increase bleeding risk. The recommended pain med is Tylenol (acetaminophen) even though Tylenol is know to be risky for liver damage, when taken correctly within the daily recommended dosage it is safe for patients with cirrhosis safer than NSAID meds. But definitely he should ask his doctor about safe ways to treat pain.
Well,  he is worried that pain is sign of something bad is happening in his liver, becide he is cured of hepC..but he is ready to stand that pain without meds, just to be sure that his liver is clear...But I will tell him your advice.. thanks Fllyin!
The liver itself doesn’t feel pain and he is getting all his tests done so for example if it was liver cancer they would detect it with ultrasound and he would not be able to feel it the only way he would know is through testing it if he began to have very serious symptoms of liver failure.

The pain could be many things from some gas trapped id a corner of his intestines to a pulled muscle. He should ask his doctor what they think. We are in delicate health with liver disease and should report worry some symptoms to our doctors.

Best to you both
Thank you Fllyin, I will tell him..I think he is afraid of liver cancer, that is normal in that situation...all the best for you and happy holidays!
Yeah we with cirrhosis are at greater risk of liver cancer than people with healthy livers. But since we are cured of hep c our risk of liver cancer is greatly reduced. Like if someone smokes they are at risk of lung cancer but if the stop they are still at risk but the risk decreases with time away from smoking.

Happy holidays to you both :-)
683231 tn?1467323017
Has he been tested for the virus the HCV RNA test? Has he been tested for liver enzymes?

Do you know how MELD score?

Does he have ascities or edema? Does he need to take diuretics? Has he had an upper endoscopy to check for esophageal varicies?

Since he has cirrhosis as I do he will still need constant follow up.

I get blood testing and abdominal ultrasound every 6 months and see my hepatologist annually.
Helpful - 0
Thanks Fllyin, he doesn't now if he is cured. Results will be in 1 month. Liver enzymes are little high, but he is worried about platelets, because he was drinking  some tea for it. Probably that tea was useless. Anyway.. thanks for your help! Best wishes and good health for you all!
There is nothing we really can do for low platelets caused by cirrhosis except to allow the liver to heal.

The issue is because of scaring in the liver this causes the spleen to enlarge as well as the liver. This in-turn causes the spleen to  sequester (hold on to) platelets. So even if you could increase your platelet production the spleen would just hold on to them as well.

Some foods can help maintain platelet levels. Lean meats such as fish, chicken and turkey are rich in protein, zinc and Vitamin B12, all of which help increase the blood platelet count. Beans contain Vitamin B9 or folate which greatly helps boost the blood platelet count. Some other foods rich in B9 are spinach, asparagus, and oranges. So this could be a good diet to follow but he should consult with his doctor for diet recommendations.

He should always ask his doctor about any herbal treatment he wants to try some can be dangerous for people living with cirrhosis. Did he check with his doctor to make sure the tea was safe for him? Did his doctor say it was alright for him to try the tea?

For platelet counts to rise the scarring in the liver must heal this will allow both the liver and spleen to begin to return to normal size and then platelet counts will begin to improve.

The only thing may possibly reverse liver scarring for some patients, is time. Not everyone will improve but the goal of curing hep c is to hopefully prevent the patient decline further resulting in liver failure.
He done his hcv RNA, 12 week s after treatment and it was good. Liver enzymes was same as now, slightly above normal and platelets low, but now lower- 58..and was 64. That is a reason we are worried..He is on vegan  diet witch means he doesn't eat meat at all. Maybe he must eat some meat for rising platelet count? And he is very tiny, maybe he lost more weight since th. It is not easy to consult doctors in our country.. only if you have extra money..so he was drinking that tea, that was recommended by his friend, herbal pharmacist, for platelet counts.His belly seams bloated, probably his spleen is enlarged.. Fllyin, you are very helpful and kind.. thanks!
If he was not detected on the HCV RNA test 12 weeks post treatment the odds he will remain virus free for life are about 99.9%  Mist doctors are calling the 12 week post treatment result on not detected cured of hep c.

If his liver enzymes are the same now as immediately post treatment that is another good sign.

His platelet count is caused by his continuing liver cirrhosis and a change that small is not significant.

Doctors do become concerned if his platelets get down to the 30’s  and may have the patient get platelet transfusions.

Stay far away from herbal treatments. At best they are a waste on money and at worst can be dangerous for someone with ESLD  (end stage liver disease) which is another name for cirrhosis.

You would not see visible signs of an enlarged liver or spleen. A bloated belly could be a sign of ascities the body retaining fluids because of cirrhosis. The stomach can become so bloated the patient looks pregnant. His doctor needs to know about this development. He may need to take prescription dietetics and for sure minimize his intake of salt. If these actions don’t work to reduce ascities  and they are very pronounced then he may need to go see his doctor to have this excess fluid drained.

Ascities is a serious complication of cirrhosis. It is caused by the restricted blood flow through the liver which causes a restriction in the main vein in the liver, the portal vein. This results in portal hypertension increased blood pressure in the portal vein.

Portal hypertension can also cause enlarged blood vessels to form in the esophagus (swallowing tube). Has he had an upper endoscopy to check for these enlarged blood vessels called esophageal varicies? These are also a dangerous symptom of liver cirrhosis and portal hypertension. Two years after I was diagnosed with cirrhosis I was found to have very enlarged varicies that needed to be banded to prevent a life threatening bleeding event.

I don’t want to worry you but he needs to have an upper endoscopy done if he hasn’t already and his doctor need to evaluate him for ascities.

But as far as his hep c it is very likely he remains hep c free and cured.
Fllyin, You give us hope and everything you told us was very useful! My husband said he doesn't have ascites in stomach, only sometimes on ankle of the foot. For enlarged varices, he is taking propranolol every day. Never had bleeding. Has little gallstones in his gallbladder. Yesterday he told me that he had dull pain in liver area all day, like something is squeezing his liver, but I told him it's going to be ok by time.. Most important is that there is no virus in it.
Swelling in the lower leg is called edema I had that and did take a diuretic for it for several years I stopped a couple of years ago because I would get very bad legs cramps a decided I would rather live with the discomfort of leg swelling than leg cramps in the middle of the night.

Yes the propranolol is a beta blocker that helps reduce the blood pressure in the portal vein reducing portal hypertension I couldn’t take it because the goal of propranolol treatment is to lower the heart rate to around 60 to reduce blood pressure but my resting heart rate is already below 60. So that was why we did four upper endoscopies over four months to band all the  I never had bleeding either the were just very enlarged. Yes a bleed is very dangerous. Signs would be vomiting up what looks like coffee grounds which is partially digested blood.  Or just vomiting up lots of blood. This is one of the ways cirrhosis kills the patient bleed to death internally.

I had gall stones also. After several gall bladder attacks they removed my gall bladder back in 2008 which was about a year after I was diagnosed with cirrhosis.

The liver itself has no nerve endings. But every internal organ is surrounded by a membrane which does have nerves to sense pain. When the liver is enlarged it pushes against this membrane which is why you feel pain in that area

Best to you both
Dear Fllyin, thanks again!
Dear Fllyin, Today my husband went to pick PCR results 6 months post th. His doctor haven't told him anything about if he is negative or positive. He took his blood again for some New and some additional analysis..I am worried about that. Is it ussual procedure when final PCR done?
One more month of uncertainty will kill me...
I got my results online through a web site many doctors use in my area called MyChart. It takes about 7 to 10 days to get results back for the HCV RNA by PCR test.

What did his  doctor say when you asked how the results came out?
I don't know about that site. There is no such thing in our country. His doctor haven't told him anything, only he must do another " control testing" and results will be in one month! Ok, I must be patient..no one can tell why they didn't told him.. thanks Fllyin!
Yeah I didn’t assume you had such a thing my doctor provides my data freely to me.

Did you ask how is test results came out? That is where I would start is by asking the question
He went there alone and told me only he must have one more testing..Last test, 12 weeks after the.was good. I hope and pray it is only standard procedure..
If his 12 week post treatment viral load test said not detectable his odds of having been cured are about 99.9% if he’d had relapsed it is normally back by then. Many doctors are calling not detectable at 12 weeks cured. Having the 6 month viral load test is the old standard of cured with the interferon meds. But many doctors like to double check at 6 months to be sure especially in patients who were more difficult to treat.

I have cirrhosis I get tested for the health of my liver every six months so I’m thinking it is more related to his liver than his hep c treatment
I hope that is a reason for control testing..Thanks again! I will let you know in one month...
Hi Fllyin,
I have a question about potential new situation. My husband is hoping he is cured of hepC..so he told me to do lab tests and see if I have a normal liver enzymes. If they turned out bad, it would ment that I got hep C from him..the point is that in that case, I could transmit virus back to him..he is worried about that. How common is that? We haven't use condoms ( he couldn't manage that)but I wasn't afraid of infection, because he told me it is almost impossible..( and I read about that),but now, he has a different perspective when it's about him..
Well yes the odds of transmission for  long-term monogamous couples per the US  Center for disease control does not suggest the need for such couples to use barrier protection like condoms.

Wouldn’t heart to get tested for peace on mind sake. But I would say just have the hep c antibody test. Sometimes liver enzymes can be elevated for other reasons. Or just have both the liver enzyme test and hep c antibody..

As you probably know even if you were to test positive for hep c antibodies  that would only mean you were exposed to hepatitis C sometime in the past. To know if you are currently infected a positive antibody test should then be followed-up with the HCV RNA test.

But yeah transmission for people like yourselves is very very uncommon

Yeah, I hope so.. Thanks Fllyin..Best regards!
Not sure what I was trying to type here: “Wouldn’t heart to get tested for peace on mind sake.” Think I meant “wouldn’t hurt” darned auto correct :-)

But yeah if you want to get tested if nothing else simply for peace of mind no harm in doing that.
683231 tn?1467323017
Low platelets are caused by cirrhosis the difference between 59 and64 is not clinically significant. Even withcite oh hep c he still has liver cirrhosis. Although with time his platelet counts may begin to improve. Mine were about 85 before I was cured. Now at 4 years post they are about 125, still below normal but significantly improved.

What you want to look for is increases in liver enzymes ALT and AST if they jump back above normal this could be a sign of the virus returning.
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Hi everyone need advice..
Chronic hepb female 30yrs, weight 128lbs , 5ft7  . am starting vemlidy next month, have  noncancerous cyst on my kidney, my viral load is 157000.000 ml and fibrosis stage 2 (8.9kp) is it really bad ? Does vemlidy has side effects on any of you ?  Am confuse and just learned about my hepatitis b, hope i can get answers here
Avatar universal
post-treatment? really don't know what you are talking about, I only know you have low platelets, however, platelets can go up and down depending on the time of day, I hope this answers your question.
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Thanks for your help. He doesn't now still his final results. We are waiting one more month for it and we are very nervous about everything... best wishes for you!
Did he have any HCV RNA tests done after he completed treatment? I had the HCV RNA test done at 4 weeks and 12 weeks post treatment.

How high are his liver enzymes are they similar to his pre treatments tests or are the still in normal range just slightly elevated but still within normal.

Is he overweight? Being overweight and especially obese can cause small rises in liver enzymes as well.
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