Platelets clumping ?

[Bali05]

Just got my wk56 bloods back and where I usually get a platelet count it reads:

Unable to report due to significant clumping.
Platelet estimate appears adequate.

Anybody ever heard of this in connection to tx ?
My platelets are usually mid to low 200s.
Last bloods wk53  platelets 214.


wk56 ,  UND < 5 IU

b

[willing]

good hypothesis however a very common response based on posted CBCs sems to be that platelets can get hammered during tx even with full rbv dosing.

An interesting comparison would be your neutrophil drop as a percentage of base. RBCs get pounded by both ifn and rbv so they're not a good comparison point but if the ifn suppression of platelets is being rescued by rbv, you should see a greater percentage drop in your neutrophil counts.

Anecdotally, it seems those reporting the worst platelet drop issues are those who can least afford them - ie where the ifn -triggered reduction is added to suppression triggered by advanced fibrosis.

[Bali05]

INF typically causes thrombocytopenia  (decline of platelet count )
Ribavirin typically causes thrombocytosis  (increase of platelets)

My guess is one suppresses platelet production and the other stimulates it.

This becomes very apparent when those meds are taken separately.
Like people who only took INF in the past had much more low platelet problems

With combo therapy this can balance itself out , as it is in my case. I am on wk58
and still have pre tx platelets .

My guess is it depends on the amount of liver damage on how the platelet
situation balances out individually with Peg and Rib.

b

[willing]

thanks - I had wondered what caused my pre-ifn  platelet spike. The abstract includes  no discussion of a likely cause and the average increase observed wasn't very big (24/uL) but it was significant (0.001) for the sample size.

Apart from boosting ifn effect, this could be another reason for those with low platelets (typically F3s and above)  to consider rbv priming.

[Bali05]

Ribavirin priming increases platelet count.
http://www.hivandhepatitis.com/2010_conference/aasld/docs/1214_2010_a.html
Also Dr. Melissa Palmer writes about it. Not a big fan of hers but she got that one right.

From what you are describing russian roulette and all I guess I am doing pretty good.

b
wk58 :-)

[willing]

Have not heard of  rbv as a platelet booster. If you have any refs on  rbv-triggered platelet increase please post - this is  a common problem around here.

I can definitely understand the reasoning behind your extension but would probably not make the same decision. After seeing loads of post-tx posts along the lines of DD's I  approach each ifn shot (like today's) with the  enthusiasm  of facing  another round of russian roulette. Adding  24 more shots to get an 22-14=8% reduction in relapse odds seems like taking on  more risk of another kind, but a lot depends on age/sx etc.

[Bali05]

Increase in platelet count during Riba preloading is an advantegous
sx of Riba. It is called Thrombocytosis . Once you add INF it usually gets offset again
because INF lowers platelets. My platelets went up to 293 during preload than straight
back to where they were with first INF shots.Still today if I increase Riba platelets
go up slightly.

Data for geno 4s is always skimpy. BTW that is another reason why I keep going the extra mile
when given a choice. Overall several studies show improved SVR with extending tx starting
with Sanchez Tapias. I see it like higher Riba dose produces better SVR rates.
I do not follow just one study but more the overall trend and direction in my decision
making.
Extending from 48 to 60 might just give me an extra 5% and it is always the same question.
What if I am one of the 5% ?

b