Cirrhosis of the Liver Community
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Avatar universal

cause of low platelets

I had NAFLD or NASH diagnosed on October  2012 and during that time my ast was 95, alt 186.
Then, I exercised and lost weight and my liver enzymes improved.
However, I have platelets  on the lower range and I do not now if it is genetic, if it is due to my b12 being on the lower range also, if it is due to diet or if it is due NAFDL/NASH.

The recent tests are as follows:

test1 (april 2013): ast: 34, alt:45, platelet: 161
test2 (march 2014): ast: 33, alt:37, platelet: 172
test3 (may 2014): ast: 33, alt:27, platelet: 148
test4 (september  12, 2014): ast: 34, alt:32, platelet: 147
test5(september  19,  2014):  ast 35, alt:36, platelet: 170

ct scan of liver on february, 2013:  normal liver and normal spleen
ecography of liver on september 19, 2104: normal liver and normal spleen.

based on the fact that my spleen is not enlarged, can I conclude that my platelet count being on the lower range is
not due to liver disease?
7 Responses
Avatar universal
Can we assume that your WBC and RBC counts have always tended to be normal, as you have not mentioned them? Another measured platelet characteristic is the mean platelet volume: MPV. Have your doctor check yours and it may help in diagnosing anything going on, if there is something of course. You may just tend towards being on the low end of normal. Relying on the platelet count can even be misleading - I have decompensated ESLD with a very large spleen, etc and I almost always fall within the normal range but on the low end.
Avatar universal
Hi and welcome
Congragulations on exercising and losing weight.   It seems evident that your fatty liver perhaps was the cause for your high liver function tests.
I think your blood work and platelet count are exceptional.  They are in the normal range.  Your CT Scans are unremarkable which indicates that they also are normal.  
You show no signs of liver disease.  Platelet counts can vary,  and you may tend to run a little on the low normal.  Honestly I would be super happy to have my tests look like yours.
Think you have no worries.  Keep up with your exercise and continue to watch your weight.  You are doing everything right.
Take care and enjoy your healthy life.

446474 tn?1446347682
"based on the fact that my spleen is not enlarged, can I conclude that my platelet count being on the lower range is not due to liver disease? "

Your platelet counts are as you say within the normal range. Which is just that, "normal". It doesn't get any better than normal.

Your platelet counts are all (except one slightly lower 147 which is meaningless) are all within the normal range. 150,000 - 450,000 typically at most labs.

There seems to be a misunderstanding of what "normal" means.

All blood tests are measured and compared to a range that most healthy people are within. Note that not everyone has blood levels within the normal ranges. The range is an average so there is a small minority of people who are healthy that have blood levels outside of the considered range. Either higher or lower. It doesn't mean they are ill. It is their normal.

Also all blood levels vary day to day normally within that normal range. As you can see as your go up then down then end over and over again. No number is better than any other number. 170 is as good as 160.

Each person's counts are different. Look at your old blood tests before your liver disease has time to progress they are probably at the lower end. That is your normal. Some are near the high end of the range others at the lower ends of the range or anywhere in between. It doesn't matter. They are all normal. As they should be.

When a hepatologist or gastroenterologist says a "low platelet count" they mean typically something less than 100, 000 usually around 60,000-70,000which is the "normal" result of someone having cirrhosis and its resulting portal hypertension  which occurs as cirrhosis advances. Portal hypertension causes and enlarged spleen among many other things which creates the low platelet values in persons with cirrhosis.

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.

A low platelet count of <30,000 can cause bleeding issues. Bleeding is the indication of a low platelet count. Platelets clot our blood. If we don't have enough platelets than either it takes a long time to stop bleeding or we can't stop bleeding which can happen to people with advanced cirrhosis and can be life-threatening. This is when we cirrhotics may receive a platelet transfusion to stabilize our bleeding issues at least temporarily such as when we have a procedure that involves bleeding such as even a minor surgery for example. The bleeding issues are ultimately caused by the underlying cirrhosis and will only remedied by having a liver transplant and a fully functioning liver.

Since you don't have cirrhosis (september 19, 2104: normal liver and normal spleen) as most people with liver disease don't, then yourself and anyone else should have a normal platelet count as you do. At least as far as liver disease is concerned.

Take with you liver doctor and they will explain this to you.
Good luck.
Avatar universal
Hector, In fact before the test of Semptember 19, 2014, I received the following e-mial from  a gastro-hepatolog:

"I have taken some time to review your nicely organized data.  I believe that you have early but definite cirrhosis as evidenced by a slightly low platelet count but a normal albumin and INR levels.  I think NAFLD is the correct diagnosis as evidenced by the return of AST and ALT and Bilirubin levels to normal with weight reduction through exercise and diet and slight relapse with return to a more sedentary life style.  The pain was likely due to the distention of the liver capsule by fat.  Your current discomfort appears to be irritable bowel syndrome with it relation to bowel movements.  I would back off such frequent blood testing and continue to follow a good diet, and maintain your weight loss with exercise."
Avatar universal
Given your consistent normal lab results from April thru September 12th, I am puzzled why your doctor concluded you had "early but definite cirrhosis" without the benefit of a conclusive test like the one you had on Sept. 19th.
Doesn't he realize how stressful this diagnosis can be to a patient and that it should  not be given (particularly in writing) without conclusive proof?  

I find that unbelievable!  Well,  I guess he has a little egg on his face...

Congratulations on exercising yourself to better health!


Avatar universal
Indeed. after I received that e-mail, I went to emergency in the miidle of night  to transfer me to an expert hepatolog. They did a blood test and everything was normal. I asked if there is a fibroscan and they said no and instead of it i did ecography of liver and spleen and doctor said everything is normal. I have shown doctors this email and they said no and nothing to be worried. I am totally confused.
Avatar universal
By that way that doctor was not my doctor. He was a gastro-hepatolog and I just asked him a second opinion by email.
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