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Avatar universal

Platelets

Before treatment my platelets were 65 and during treatment they went up to 84 but now 12 weeks after treatment they're down to 75. My white blood cells are also a bit down and never have been before. Everything else is normal. AST, ALT, All Phos are all very normal and down from being very high before treatment. I understand what's going on with the portal hypertension and enlarged spleen with regard to low platelets but what I do not understand is how/why with good liver enzymes this is happening.

It seems like the low enzymes indicate the liver is working better, so why are the platelets and wbc's worse?
20 Responses
Avatar universal
My platelets were in the 90,000 range for 20 years and started to fall further as my fibrosis got worse. My platelets have remained between 55,000 & 65,000 for many years but my INR numbers have been perfect. Platelets that make it through an enlarged spleen can be deformed so it is hard to accurately count the actual number. "IF" my liver gets better over time as I hope it will, and my PHT gets better my IDS believes that my platelets will increase. My platelets remained the same during my treatment with S&O.
At my last visit (SVR24 cured/discharged) she said that the ID Clinic was seeing remarkable things happening to their patients who are now cured. People are literally coming back from the brink.
Bucky
2059648 tn?1439766665
Hepatitis C treatment by itself is taxing on your liver.  Most all drug therapies are.   Just because the treatment is easier doesn't mean there are no effects.
I think this is the main reason I don't agree with those who want to run out and have a drink after completing treatment.   Even after SVR.   It takes time for your liver to recover from hepatitis C and the treatment itself.  Give your
body some time to catch up.   My platelets were at an all time low during treatment.   Now 2 years post treatment ........my platelets are higher than before treatment.

Hope this is helpful
Avatar universal
Depending on the amount of liver damage it is common for ones platelets to be low. With the wide range in platelet levels your numbers (65, 84, 75) are really no different as they will bounce around on any given blood draw and will have nothing to do with your AST or ALT numbers.

In time as your liver begins to heal your number might rise. But your in no danger at 75. Good luck to you.
Avatar universal
But it seems to me that if your liver is doing better, your platelets should get better and not worse.
Avatar universal
Your liver is now not under attack. That's why your liver enzymes are normal, that said it takes time for ones liver to heal. Much longer then 12 weeks. I am over 5 years post treatment and my platelets are still low but I am also cirrhotic so they will always be low.
2059648 tn?1439766665
What your quoting is a marginal difference as Cando stated.   You were at 65 before treatment.   It takes time for these values to change.   How damaged your liver is may determin how long this may take and if your values improve.
Like Cando stated your not in danger.   Give it time.
Avatar universal
That's normal nothing to worry about.  It can take years to go up. Hopefully they will get closer to 100 at 24 and 48 weeks

MY platelets were the lowest ever  6 weeks post tx.

GT2 SOV/RBV 12 weeks  SVR
My platelets were around 90 pre tx, went as high as 127 during tx.  Then 74 lowest 6 wks post tx.,  97 SVR 12   107 SVR24

My AST & ALT went to normal 2nd week of treatment and have been since

HectorSF answers some questions about platelets here

http://www.medhelp.org/posts/Hepatitis-C/Raising-platelets/show/2164962

Best wishes
Avatar universal
As Jimmy and Can Do said, it isn't that you had hep C that caused your platelets to be low. It's the fact that you had cirrhosis. And it will take a very long time to get improvement in your fibrosis, if it improves at all. The goal for those of us with late stage hep C is to stop the progression of the disease. An improvement in cirrhosis is the icing on the cake for some of us. Hopefully you will be one of those who gets a decent improvement but it certainly does not happen overnight.

My platelets hung at around 110-120 before treatment. During treatment they went up as high as 175ish. Now they are around 130-140 but I have been clear for over two years. We have to be patient.
Avatar universal
I realize platelets are not truly worrisome until they get below 30-35 and I understand they are low due to cirrhosis and the portal hypertension that develops with it and the enlarged spleen that gets so due to holding onto the platelets. What made me curious was the lack of a correlation between the enzymes and the platelets. Perhaps the liver getting better has little to do with portal hypertension but it seems like it should to me. Oh well.
Avatar universal
Mine too. Went from 100 to 115 and pdown to 65 after treatment.
Avatar universal
This thread is very timely as i completed treatment 8 mths ago (sovladi/olysio) obtained svr but my platelets have been decreasing.  They have always hovered in the 50's since dx of cirrhosis (approx 5 years ago) but now are at 30.  I'm a little worried but my doctor says they don't get concerned until they are 10 or lower.  I hope they go up.  I take very good care of myself and am listed for transplant but meld is relatively low (14).  
Avatar universal
Actually there is little correlation between platelets and liver enzymes. Inflammation causes liver enzymes to leak out of liver tissue. With the virus gone the inflammation decreases. It really doesn't mean your liver is working better. Liver function tests as we patients like to call ALT/AST has nothing to do with the function of the liver. Remember that 1/3 of hep C patients never have elevated liver enzymes but their livers are still being damaged by the virus. So, it isn't a good marker for what is going on. Hang in there. I think with time we will all see a slow rise in platelets.
Avatar universal
That is so good to hear,  Bucky. Thanks for sharing what your doc said.
Avatar universal
Thanks Bucky. That's really good to hear.
I'm thinking that it probably takes a year or so of having a more healthy liver before other effects of cirrhosis begin to get better, like the enlarged spleen getting smaller, etc.  That is, as long as we eat right, don't drink, and get a bit of exercise along with a decent social life. I have very high hopes for my liver.
Avatar universal
Thanks Bucky. That's really good to hear.
I'm thinking that it probably takes a year or so of having a more healthy liver before other effects of cirrhosis begin to get better, like the enlarged spleen getting smaller, etc.  That is, as long as we eat right, don't drink, and get a bit of exercise along with a decent social life. I have very high hopes for my liver.
Avatar universal
You are right. The liver getting better will improve portal hypertension. But again, it takes time for a liver with fibrosis to begin to heal. And when the fibrosis is on a cellular level like it is with cirrhosis, it will take a long time, if it happens at all.
Avatar universal
This may help somewhat.  Was on Sovaldi and Ribaviren for 12 weeks.
Pre Tx my platelets were 125
During Tx they were in the 250 range
Post Tx the were 118

Certain Txs for some individuals will raise platelet counts.  When Tx is over they will typically go back to where they were pre treatment.

It's been over 1 year since Tx ended and they are now gradually coming back up and are now 134.  What your platelets due during Tx is not indicative of where they will remain.

The most reliable platelet count is what the # is when Tx is over.  After that they will slowly rise if you reach SVR.  It may take up to 5 years to see a significant rise if at all.

Hope this helps
......Kim
BTW.  Not everyone experiences this heightened # during Tx.  Think it depends on many factors including Tx drug/drugs
Avatar universal
Thank you for a post explaining what many people want to know. The key is slowwwwly. Five to seven years is what Halt C taught us.
317787 tn?1473358451
Hey there! Everyone has given you great advice. It does take time. My platelets were at 65 when I was first DX. After tx they were above 100. It took about two years for them to get to the low normal range. I am happy that you are SVR and your enzymes are good. Take care my friend ;)
Avatar universal
Thanks Kim and Dee. It's good to hear from others who have also treated. I talked to my doctor today and he said things look so good that we should see platelets go up in a year or so.
Your friend on our journey. Take care.
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