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Cirrhosis of the Liver Community
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is low wbc and low platelet a problem?

I was diagnosed with Hep C and also have Hep B but not active. I went on Epclusa and was cleared.  I have stage 4 liver disease but feel ok most of the time. My spleen is enlarged and sometimes is uncomfortable and have noticed lately my liver is causing discomfort but not unmanageable.  My 3 month and 6 month blood tests are showing my wbc still going lower it is now at a 1.7 and my platelets are 78.  My last blood tests show an increase in glucose and kidney function starting to be impaired.  I guess my question " is this normal? has anybody experienced this? do I need to be concerned about low wbc and platelet?
4 Responses
683231 tn?1467323017
I don’t know about the low WBC mine is normal. Low platelet counts are a common symptom of cirrhosis indicating the development of portal hypertension this is also associated with your spleen enlargement causing your spleen to sequester (hold on to) platelets.

My pre treatment platelets were around 80 to 90 since cure 4 years ago they have slowly risen to now 125 still below normal. Low platelets aren’t much of a concern until the get lower than 50 or 30 where your doctor may consider blood transfusion or removal of the spleen
683231 tn?1467323017
Just to add you have liver cirrhosis and need to be followed by a hepatologist associated with a liver transplant center. Your platelet count isn’t normal but at this point not dangerously low where your doctor would need to take action. Low platelets are common in liver cirrhosis and is associated with portal hypertension a symptom of cirrhosis.

Most people will feel ok in early compensated cirrhosis but if your liver disease continues to progress eventually you could develop symptoms of liver failure like ascities (very swollen stomach) esophageal varicies (enlarged blood vessels in the swallowing tube) and hepatic encephalopathy.
1 Comments
Thank you, for sharing your knowledge, it feels better to talk to someone about it.
683231 tn?1467323017
Causes of low WBC per webmd

Bone marrow problems: The spongy center of your bones, which is called the bone marrow, makes blood cells. Low WBC counts are often linked to bone marrow problems. Being around certain chemicals, like benzene and pesticides, as well as some types of cancer and cancer treatments including chemotherapy and radiation, can hurt your bone marrow's ability to make WBCs.

Autoimmune disorders: Some autoimmune diseases, like lupus and rheumatoid arthritis, will tell your body to attack and destroy its own WBCs.

Infection: Viruses can affect your bone marrow and cause low WBCs for a while. Severe infections, like blood infections, can lead to your body using up WBCs faster than it can make them. HIV kills a specific kind of white blood cell.

Medicines: Some drugs, including antibiotics, can destroy WBCs.

Nutrition: Not eating well or low levels of certain vitamins, such as folic acid and B12, can affect how your body makes WBCs. Alcohol abuse can mess with the nutrients in your body and with WBC counts, too.

Spleen problems: The spleen also makes WBCs. Infections, blood clots, and other problems can make it swell and not work the way it should. This will drop your WBC count.

10 Comments
Thank you, I have an appointment with a hematologist. It could be a number of those things.
I guess you mean hepatologist which is a liver specialist (hepa meaning liver)

A hematologist specialized in blood disorders (hema meaning blood)

My phone tries to auto correct hepatologist to hematologist  
Lol. No, it's actually a hematologist. My family physician  is sending me there.  My physician hasn't talked to me about a liver specialist. It could be because I live in the middle of the ocean and we are pretty limited in care, or ???? When I began all of this I was under a different insurance that sent me off island. I had to switch insurances and now am under the care of a family physician.
They may be sending you to a hematologist because of the low platelet count but really if the cause of low platelets is cirrhosis you should see a hepatologist

Family care physicians are not expert in more complicated medical situations. Actually my general practice Dr also mistakenly sent me to a hematologist because of my low platelet count. The hematologist said there was nothing he could do because my low platelet count was because of my liver disease
Your right I think it was a fibroscan not strand test and I think I m probably going to hear the same thing from the hematologist.  Did you say you don't have low wbc?  Or is it normal low?  Mine has been low the whole time but once it came back critically low I m supposed to go this week for another one? Maybe it was just an off day. So the cirrohsis is always going to effect my wbc and platelets?
I guess I should try to find a hepatologist
Your insurance may require you to have a referral to a hepatologist.

My WBC has always been normal. As far as platelets when the liver is scarred this can cause an increase in blood pressure moving through the main blood vessel in the liver called the portal vein. You won’t see a change in blood pressure at your arm. This pressure increase in turn causes the spleen to enlarge and sequester platelets
WBC
5.4
normal range 3.4 to 10.8
My WBC is 1.7
Yes yours is below normal as you already said. From what I already found and posted here could be a lot of things as well as cirrhosis causing it. The low platelets are probably caused by cirrhosis.

Back to your original question, cirrhosis can also impact kidney function and as far as blood glucose if you were not fasting before the test there are no standard numbers for glucose. Glucose tests are only meaningful if fasting.
683231 tn?1467323017
And from the Mayo Clinic

“Decreased white blood cells and platelets in your blood can be the first sign of cirrhosis.”

You should discuss all this with your hepatologist
4 Comments
Yes I do have cirrhosis level 4
A fibrosis score of F4 is by definition cirrhosis. There are no levels of cirrhosis there are only compensated and decompensated cirrhosis.

Compensated cirrhosis is where the liver, although damaged and scarred, is still able to adequately perform its important functions. Decompensated cirrhosis occurs when the liver is so badly damaged it can no longer perform its jobs and symptoms begin to develop.

There are levels of fibrosis (liver scarring)

The fibrosis stages range from F0 to F4:

F0: no fibrosis
F1: portal fibrosis without septa
F2: portal fibrosis with few septa
F3: numerous septa without cirrhosis
F4: cirrhosis

I was diagnosed with F4 liver cirrhosis with liver biopsy in January 2008
As far as I know it is an f4 confirmed by ultrasound strand test? I do not have problems with ascites as of yet. I saw a surgeon about my spleen, but decided not to have it removed. I am a jehovah's witness and we do not partake in blood so once things progress I will only be able to look g into bloodless surgeries or nothing at all.
Ultrasound does not diagnoses cirrhosis. An ultrasound can confirm a coarsened surface texture to the liver that looks like cirrhosis but is not the way to diagnose liver cirrhosis.

I haven't heard of a strand test. I tried to google with no luck. Could it have been a Fibroscan test?

Cirrhosis can be diagnosed with liver biopsy. There are newer less invasive tests like the Fibroscan test which is kind of like an ultrasound except it produces a thump that can estimate liver stiffness reasonably at no damage or significant damage like F4 but less accurate in the mid ranges of damage. The doctor or nurse in office will take several readings and you will be told a score. My last Fibroscan this February was 29 any score above 14 if the cause is hepatitis c is considered F4 aka cirrhosis.

There is another test a blood test called fibrosure which can also estimate liver stiffness and similar to the Fibroscan is most accurate at the extremas and less accurate in the mid ranges.

Ascities is a symptom of the beginnings of decompensation as I said most wont have symptoms initially. My first symptoms were lower leg edema and a low platelet count. I only had a small amount of ascities that was only detectable by ultrasound. Since my hep c was cured in May 2015 my small amount of ascities has resolved. I still have lower leg putting edema and my platelet count is still low at 125 but much improved from 80 before treatment.

If you should later develop decompensated cirrhosis the only treatment to extend life for someone with a diseased failing liver is a liver transplant.  So hopefully you never get there.

The removal of the spleen due to low platelet count is a last resort when platelets are below 50 and probably less than 30.

Do you know the cause of your liver cirrhosis? If you can treat the cause of cirrhosis no further damage will occur and the liver may begin to heal with time
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