Low platelet count - how low would make you worry

[hepcandme]

I recently had 2 surgeries - my platelet count the first time was 70 (early December) . This last time, a week ago, it was 59

During both procedures, my surgeon gave me platelets intravenously during the surgery so clearly she was concerned with the low number. I always think of normal as around 140 but is 59 Too low? Below 50?

Have people monitored platelet levels exclusively while on treatment? How do you tell if they are dropping? Do you feel or have symptoms of anemia?

I'm done with the surgeries, btw
Thank you to everyone for their support and thoughts

[can-do-man]

Low Platelets on treatment is caused if one is taking Interferon. Low platelets and anemia our two different things. Anemia is mainly due to Riba and no there are no symptoms of low platelets as their is when one is anemic. And yes yours are very low. Mine run around 60 due to being cirrhotic. Could there be a problem only if one would have an accident where there is a lot of bleeding. Always make sure even if you go to the dentist they are aware of your low platelet level.

As for anything one can do to raise them not really. Once treatment is over and there is healing it could be possible they will go up. Good luck

[hepcandme]

hmmm

Clearly I need to do some research about low platelets. The good news is that I never seem have a difficult time with blood clotting despite what one would expect from my MELD scores

I am cirrhotic as well

[Dee1956]

Hey there, when I was first diagnosed with HCV it was brought to my doctors attention by my platelets being low at 67, I also had odd shaped red blood cells.  She sent me to a blood specialist who dx me with HCV.
At the time I was taking a lot of Advil for a torn tendon.  I stopped the advil, aspirin and my platelets went up.  At the time they had to be at least 100 to start a HCV trial.  I got that high.  Once I was SVR my platelets came up to within normal limits.  During tx they can go as low as 50 before they think about stopping tx.  Some specialists will let it go even lower.

[hepcandme]

But is one in any danger when it gets below 50?

And, are there indications besides blood tests that platelets are getting lower?

[CoWriter]

As cirrhosis increases, you become more anemic and the platelets go down.  Normal is 150.  As can-do said, bleeding after an injury can be serious.  You also have to watch for esophageal bleeding.

Spontaneous bleeding can happen if your platelets are very low.  So I once asked one of the hepatologists how low do platelets have to be to spontaneously bleed and whether he'd seen somebody spontaneously bleed.  He said around 10 or 15 and he had seen a few patients spontaneously bleed but they were very ill people who were in the hospital at the time.

Some medications can lower platelets.  For example Zantac which is an anti acid med can lower platelets.  So check to see if any of the meds you take can lower platelets.  

Also, H.Pylori infection can cause low platelets.

Co

[flyinlynn]

I believe low hemoglobin is anemia while low platelets is called thrombocytopenia.

My platelet count runs about 80 -90 due to my cirrhosis and portal vein hypertension which all result in an enlarges spleen due to the sequestration of platelets

from web md
If you have thrombocytopenia, try to:

    Avoid activities that could cause injury. Ask your doctor which activities are safe for you. Contact sports, such as boxing and football, carry a high risk of injury. Other sports that your doctor may ask you to refrain from include horseback riding and downhill skiing.
    Drink alcohol in moderation, if at all. Alcohol slows the production of platelets in your body. Ask your doctor whether it's OK for you to drink alcohol.
    Use caution with over-the-counter medications. Over-the-counter pain medications that can affect your platelet function include aspirin and ibuprofen (Advil, Motrin, others).


also found this it is about thrombocytopenia induced by chemo but it looks like it has some good info

http://www.oncolink.org/treatment/article.cfm?c=145&id=69

"A normal platelet counts ranges from 150,000 - 400,000 per mm3 of blood. While receiving chemotherapy or radiation therapy, your platelet count may drop. Your platelet count will be checked throughout the course of your treatments. Any time your platelet count drops below 50,000 per mm3 you are considered to be at increased risk for bleeding. If your platelet count drops below 10,000 per mm3, you may require a transfusion of platelets."


about Zantac: Ranitidine-induced thrombocytopenia: A rare drug reaction.

Drugs that can affect plate count:

There are several drugs that can affect the results of platelet function tests. Some of these include:

    Aspirin and aspirin-containing compounds (salicylates)
    Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and any over-the-counter medications that contain NSAIDs
    Tricyclic antidepressants
    Antihistamines
    Some antibiotics

[AWorriedMom]

While interferon can cause low platelets, so can cirrhosis. My information is that a spontaneous bleed can occur with platelets below 20,000. As you have already experienced, when someone with thrombocytopenia needs surgery, the doctor can ask for a transfusion of platelets. Low hemoglobin can be caused by ribavirin. Both of these conditions can be caused by cirrhosis alone.

Platelets are monitored during treatment but they are also monitored in people with late stage liver disease. With platelets at 50,000 you should be careful when using razors, or other sharp objects, as one can bleed easily from a tiny cut. Hopefully, if yu are treating and you get an SVR, your platelets may rise as time goes on.

[dontworry_behappy1]

Nose bleeds are common in people with very low platelets.

[Livelife777]

Linda.  Everyone has said what I have read regarding platelets.  I think you have to get concerned if they hit 20,000.  Avoid any blood thinning agents such as alcohol, aspirin, and ibuprofen as these typically can be found in everyday products.
I did not think that you are taking Riba, but only Harvoni?  Should Riba be in the picture your platelets can swing either way.  I'm typically in the low 100s, but while on Riba mine went up to 200+.  Don't believe that's the norm but a few of us on Medhelp did experience this elevation.
Once Tx is over your platelets will go back to your prior #.  At 6 months post Tx they should start to rise.  Mine post Tx went from 118-134.  A do believe alot of that tho has to do with degree of Cirrhosis.
There is nothing that I know of that will increase platelets.  Supposedly (sketchy) leafy greens will raise them but think that's just a temporary fix.  The concern with low platelets is fear from an accidental deep cut or internal bruise.  You can bleed under the skin as well as surface bleeds.  Just be careful till Tx is over and you see an increase.  As stated if worrisome a transfusion will help but that is also temporary.
Don't know your varacies issues.  You may want to see what your Hepa has to say regarding that complication.
Yes I know its alot to take in but when your cured from the Harvoni you can take a breath and relax.  You have seen the worst of it and once you reach SVR its all uphill.
Just know we are all rooting you on!
.....Kim

[hepcandme]

Thanks for everyone's great comments.

I haven't actually started the Harvoni treatment yet. I'm in the hurry up and wait stage

Before my treatment was delayed for a few months, I had been scheduled to add the Riba with the Harvoni, the efficacy of which we have discussed extensively here

I am meeting with my team next week and just want to understand what this low platelet count will mean since platelets can be affected by Riba. Whether it is something that I should be concerned about.

Platelets infused during surgery raise levels of platelets for only about 3-4 days

I just reviewed my platelet counts for the last 3 years and they have never been higher than 80. Sadly, this must be caused by the cirrhosis

I don't drink, take any NSAIDS or meds of any kind that would adversely affect liver function or platelet count

Will see what the docs say. Thank you as always for the great info and giving me some ideas of what research I need to conduct

~ Linda

[flyinlynn]

Hi Linda

Have my first 1200 mg of Riba swimming with my Harvoni today.

So far nothing to report I am mor econcerned about my hemoglobin counts my doctor has added extra blood tests for CBC so will be checking after 1 week of riba.

Good luck to you

You've got this!
Lynn

[Jk12345]

I would just keep an eye on it periodically but working in a hospital we see people run chronically low they even discharged a patient with a platelet count of 10,000 or lower if it's chronic they usually aren't too worried as long as your not dropping a ton but you stil need to be careful with things that could cause injury but don't stress too much! Like I said just be careful with things that could cause injury otherwise live your life and follow up as you would with your docs :)

[AWorriedMom]

I would ask your team whether they are concerned about your low platelets. I think ribavirin usually needs interferon to suppress the bone marrow. My personal experience was that on Peg and riba, my platelets would drop to 60,000. But in the abbVie trial, they never went below 120,000. You may be worrying unnecessarily. I hope so.

[michniak]

hate to go here, but I will.  My Mom passed in October, from a blood condition that we believed was caused by Solvadi / Olysio.  She was fine in January.  Doctor approved her treatment to go on Solvadi, not sure why, yada yada.  She started treatment in April, in June she was very ill.  We had gone to the doctor over and over and noone could find anything.  By July she collapsed and was admitted to the hospital with what turned out to be blood viscosity, very low platlet count.  Test after test, scan, X-ray nothing could present as to what was causing this and what caused this demise. All factors pointed to Solvadi / Olysio but her hep doctor refuses to accept our findings.  She started to need bi weekly platelet transfusions.... as well as plasmaphereiss... nightmare.  In October she was hospitalized again for very low platlets... still no diagnosis as to what was causing this blood disorder, again all pointed to the beginning of when she started taking Solvadi Olysio.  On October 6th, she had a massive stroke to her brainstem.  She was awake for a little while, but fell into a coma and died one week later.

Yes a nightmare.  Yes extremely painful.  I've been kicked off hep forums over and over telling my story.  Lucinda Laporte the head nurse over on HepMag has yet to allow me back in on the forum because she refuses to hear my story and announce that Solvadi and Olysio killed our Mom.

My warning to you... please be very careful with the low platelets.  We did all we good, but we couldn't save our Mom.  Hopefully we can save others by our stories.  Hugs.  If you want to chat more, my email is ***@****.  Hugs and prayers.

[michniak]

or forgot to mention, she was bleeding everywhere... through her nose and mouth, still doctors could find nothing.  she was bleeding in her eyes.  If I didn't want to die from the pain of her loss and from the pain of remembering how she suffered after taking that damn drug, I would sue but I can't, cause I'd surely die if I'd had to relive this for the next few years in courts.  Hopefully he will get his when he meets his maker.  God bless.

[JimmyMose]

Sorry your mom passed away.  FYI posting of email addresses is not allowed in the forum and is auto bloocked.  In my opinion this reply comment it not appropriate for this question.  You should post a new question but refrain from drawing an absolute factual conclusion that her death was caused by Sovaldi/Olysio unless you can provide a reputable varifiable heath professional link stating that.  It will be up to MH moderator if your post will be allowed here.

[flyinlynn]

Just got my 11 week test results oh Garvoni and week 2 on Riba.

I have the expected decrease in hemoglobin from  the Riba and am now slightly anemic but woo whooooo! My platelets have increased to almost normal levels 143!!!!! That is the first time I had seen anything over 90 in at least 5 years this Harvoni aka Sovaldi ledipasvir is a miracle !

[michniak]

as soon as you can provide a reputable verifiable health professional that said it didn't ;)  they can delete the post, doesn't matter, wouldn't' be the first time... my story is everywhere.. it's been reported to the FDA.  don't understand why everyone wants to defend the medicine... at the time my Mom was sick I was looking for answers everywhere and anywhere, I would have loved to come across a post from someone's experience... just trying to help.... perhaps some out out there is having the same experience... it would be a crime to not put all stories out there.

[flyinlynn]

Well as this medicine is saving my life I will.

Sorry for you loss of your mother but her experience was not that of the majority of patients.

How old was she did she have advanced liver disease or other health conditions that also could have caused her passing or maybe an increased sensitivity to Sovaldi?

[JimmyMose]

My personal opinion is I don't agree with the way you tell your story.
Maybe describing the details and saying something like.  So far in my opinion because no other cause has been found for the low platelets that caused a blood disorder that caused my mother death.   It began after she started tx with Sovaldi and Olysio,  the treatment providers weren't that concerned so my best guess so far it was Sovaldi and Olysio treatment and or the failure of the treatment providers to stop tx sooner that caused her death.

I might agree that there should be a medical investagation into the cause of her death.

I will not respond further in this thread about your case.

[hepcandme]

Lynn, congrats!

You're swimmin in platelets. That is so awesome!

You go girl!

[flyinlynn]

Dozens of causes of low platelets

What Causes Thrombocytopenia?

Many factors can cause thrombocytopenia (a low platelet count). The condition can be inherited or acquired. "Inherited" means your parents pass the gene for the condition to you. "Acquired" means you aren't born with the condition, but you develop it. Sometimes the cause of thrombocytopenia isn't known.

In general, a low platelet count occurs because:

The body's bone marrow doesn't make enough platelets.
The bone marrow makes enough platelets, but the body destroys them or uses them up.
The spleen holds on to too many platelets.
A combination of the above factors also may cause a low platelet count.

The Bone Marrow Doesn't Make Enough Platelets

Bone marrow is the sponge-like tissue inside the bones. It contains stem cells that develop into red blood cells, white blood cells, and platelets. When stem cells are damaged, they don't grow into healthy blood cells.

Many conditions and factors can damage stem cells.

Cancer

Cancer, such as leukemia (lu-KE-me-ah) or lymphoma (lim-FO-ma), can damage the bone marrow and destroy blood stem cells. Cancer treatments, such as radiation and chemotherapy, also destroy the stem cells.

Aplastic Anemia

Aplastic anemia is a rare, serious blood disorder in which the bone marrow stops making enough new blood cells. This lowers the number of platelets in your blood.

Toxic Chemicals

Exposure to toxic chemicals—such as pesticides, arsenic, and benzene—can slow the production of platelets.

Medicines

Some medicines, such as diuretics and chloramphenicol, can slow the production of platelets. Chloramphenicol (an antibiotic) rarely is used in the United States.

Common over-the-counter medicines, such as aspirin or ibuprofen, also can affect platelets.

Alcohol

Alcohol also slows the production of platelets. A temporary drop in the platelet count is common among heavy drinkers, especially if they're eating foods that are low in iron, vitamin B12, or folate.

Viruses

Chickenpox, mumps, rubella, Epstein-Barr virus, or parvovirus can decrease your platelet count for a while. People who have AIDS often develop thrombocytopenia.

Genetic Conditions

Some genetic conditions can cause low numbers of platelets in the blood. Examples include Wiskott-Aldrich and May-Hegglin syndromes.

The Body Destroys Its Own Platelets

A low platelet count can occur even if the bone marrow makes enough platelets. The body may destroy its own platelets due to autoimmune diseases, certain medicines, infections, surgery, pregnancy, and some conditions that cause too much blood clotting.

Autoimmune Diseases

Autoimmune diseases occur if the body's immune system mistakenly attacks healthy cells in the body. If an autoimmune disease destroys the body's platelets, thrombocytopenia can occur.

One example of this type of autoimmune disease is immune thrombocytopenia (ITP). ITP is a bleeding disorder in which the blood doesn't clot as it should. An autoimmune response is thought to cause most cases of ITP.

Normally, your immune system helps your body fight off infections and diseases. But if you have ITP, your immune system attacks and destroys its own platelets. Why this happens isn't known. (ITP also may occur if the immune system attacks your bone marrow, which makes platelets.)

Other autoimmune diseases that destroy platelets include lupus and rheumatoid arthritis.

Medicines

A reaction to medicine can confuse your body and cause it to destroy its platelets. Examples of medicines that may cause this to happen include quinine; antibiotics that contain sulfa; and some medicines for seizures, such as Dilantin,® vancomycin, and rifampin. (Quinine is a substance often found in tonic water and nutritional health products.)

Heparin is a medicine commonly used to prevent blood clots. But an immune reaction may trigger the medicine to cause blood clots and thrombocytopenia. This condition is called heparin-induced thrombocytopenia (HIT). HIT rarely occurs outside of a hospital.

In HIT, the body's immune system attacks a substance formed by heparin and a protein on the surface of the platelets. This attack activates the platelets and they start to form blood clots.

Blood clots can form deep in the legs (deep vein thrombosis), or they can break loose and travel to the lungs (pulmonary embolism).

Infection

A low platelet count can occur after blood poisoning from a widespread bacterial infection. A virus, such as mononucleosis or cytomegalovirus, also can cause a low platelet count.

Surgery

Platelets can be destroyed when they pass through man-made heart valves, blood vessel grafts, or machines and tubing used for blood transfusions or bypass surgery.

Pregnancy

About 5 percent of pregnant women develop mild thrombocytopenia when they're close to delivery. The exact cause isn't known for sure.

Rare and Serious Conditions That Cause Blood Clots

Some rare and serious conditions can cause a low platelet count. Two examples are thrombotic thrombocytopenic purpura (TTP) and disseminated intravascular coagulation (DIC).

TTP is a rare blood condition. It causes blood clots to form in the body's small blood vessels, including vessels in the brains, kidneys, and heart.

DIC is a rare complication of pregnancy, severe infections, or severe trauma. Tiny blood clots form suddenly throughout the body.

In both conditions, the blood clots use up many of the blood's platelets.

The Spleen Holds On to Too Many Platelets

Usually, one-third of the body's platelets are held in the spleen. If the spleen is enlarged, it will hold on to too many platelets. This means that not enough platelets will circulate in the blood.

An enlarged spleen often is due to cancer or severe liver disease, such as cirrhosis (sir-RO-sis). Cirrhosis is a disease in which the liver is scarred. This prevents it from working well.

An enlarged spleen also might be due to a bone marrow condition, such as myelofibrosis (MI-eh-lo-fi-BRO-sis). With this condition, the bone marrow is scarred and isn't able to make blood cells.

[dontworry_behappy1]

Sorry about your mother.  As "flyinlynn" posted... there are many causes of low platelets.   The problem with drug therapies is there are many side effects that can happen.  These are new drug therapies that still has an unknown possibility.  I personally treated with Incivek that has been taken off the market.  That didn't happen before many treated with this very toxic therapy.
Some people had horrible side effects and even a few people died.  This is very sad.  But many were cured of Hepatitis C with Incivek.   They also found that a much smaller dose of Incivek would have worked.   So we all were given a overdose to cure our hepatitis C.  

Again,  I want to say how sorry I am about your mother.  It's extremely hard to
go through the loss of a mother.  I lost mine at 20.   From batched cancer treatment and I too watched in horror.   I know how difficult this is for you.  But there is always a chance that things can go right and be ok.....and always a chance things can go terribly wrong.   In the cause of our mothers that's exactly what happened.  It doesn't happen to everyone but why did it have to be our mothers?  I'm living today because my mother came before me and forged the way for breast cancer to stop killing women at an alarming rate.
I watched her suffer more than any could imagin.  I know your pain.

My mother asked that her body be donated to research.  As she wanted to at least leave someway to help us in the future.   She did....I'm a 15 year breast cancer survivor.

Michniak,
Not everything is absolute.  Things always don't go as planned.  Everything is not always as it appears.   We are all of different makeup and sometimes the effects of drugs work differently on your body.  There is weaknesses that set you aside from others.   But at the same time there are others who are cured and are living proof these drugs do work.  

If you read what "flyinglynn wrote the causes are many for low platelets.  I have never got over the loss of my mother.   What the medical profession did to her.  But did they really know what was happening at the time?   No they didn't!   It wasn't till years later that breast cancer became a cancer that we would survive.   The women who posted this thread is proof of that advanced technology in the treatment of breast cancer.   She recently survived breast cancer.  

Respectfully Sorry For Your Loss

[dontworry_behappy1]

I was so moved by your story that I went back and read your posts.  The reason your mother's doctor treated your mother's Hepatitis C?  I'm no doctor but have experience with blood cancers.  

Your mother was in remission from Lymphoma (a cancer that has been connected to Hepatitis C).   Getting rid of the Hepatitis C could have benefited your mother.

Your mother died of waldenstrom. Which is a rare cancer.   Sure this was hard to detect and she was on hepatitis C treatment which caused confusion.

I'm really sorry that your in so much pain.  But your mother was also 80 years old and has past health issues with her blood.   The doctor's did find out she had another health issue while she was on treatment.  

I hope this helps you have peace.