low platelets and txt

[Renee543]

Does anyone know if you can do txt with already low platelets? (127) and INR of 1.13?
Going to see my Gastro this week and I am sure he is going to propose getting on txt if I am able to with low platelets. From what I understand the txt cause platelets to drop. thank you

[Renee543]

That is kinda where I am at. I put off doing txt in a trial with Telaprevir Phase ll last year because I did not want to end up in the plecebo group. That was a very hard choice for me to make but at the time my platelets were fine and my blood work much better. Just found out last night I cannot be in the Teleprevir Trial Phase lll cuz they do not have any openings. So was not meant to be. I will wait til Summer when the Gastro says he will be able to treat with it. In mean time am just going to try to get as healthy as possible and take care of my sick liver. As I understand I cannot do a lot about the low platelets anyway.

[lalapple]

Mine dropped to around 80 during tx.  I remember there was someone here with dangerously low plt during tx and had to get a blood transfusion since there are no rescue drug for low plt unlike those for anemia and neutropenia.  I would consult a hemo and get your gastro to discuss this topic.  It's better to take into consideration for what could happen.  Just be prepared.

[cam76]

i started in the 89 platelets at haft dose at 6 month und .i go in for 1 year in march you can do treatment with low platelets

[FlGuy]

If and when you get to a point in which you are committed to treating the HCV (either with current meds or the new stuff later on) the condition of your liver (the stage) becomes somewhat irrelavent.  Sounds crazy, but there's some reasoning.  If you were to treat, and say there's a 50% chance of curing (old meds) or 75% chance of clearing (new meds) at the point at which you become svr (cured) it is likely that your liver will repair itself from fibrosis and (as experts suggest) anything less than mild cirrhosis.  If you don't cure with treatment then the condition of your liver that matters is the going forward condition of your liver post treatment.

You are fortunate that you're pondeing these things at a point in time when there appears to be significant advancement in treatment opportunities and prospects.  The GI seems to be correctly attentive to the HCV and not necessarily platelets.

[Renee543]

I was reading one of your older posts from 2007. You were talking about how you had a slightly enlarged spleen too. You were very hopeful in the numbers your were getting from txt. Are you SVR'd now? How are your platelets? That is interesting to me that you switched to the Hematologist. I don't know if you have read some of my posts but I am having problems with the Gastro and Hematologist being on same page too. Gastro only seems concerned about the HepC (totally going by 10mo.old biopsy, which said mild fibrosis) but Hematologist concerned about high ferritin and enlarged lymph node (hence another CT next week to keep eye on it). She did not say anything about Cirrhosis but I do know my left liver lobe is slightly enlarged and spleen high side of normal and platelets 127. Combined all of this is concerning to me and I do not totally trust that biopsy (which was done on right lobe). So I plan on getting CT and then seeing the Hematologist. I will ask her about the correlation between all of this. I feel like I find out more from reading from pp like yourself who have actually gone thru this, than from the doctors.

[Renee543]

WBC 5.82

[GoofyDad]

I don''t want to cause you undue concern - but low platelets and a moderately enlarged spleen are conditions I associate with the beginings of cirrhosis. Where does your white  cell count stand?

One other note on platelets - mine jumped alot on tx, and can still swing as much as 20 pts from reading to reading. I definitely watch trends more than absolute numbers.  

[Renee543]

That was an encourging msg. I don't think I have cirrhosis like you did but I think there are changes going on. This time last year my numbers were much better and I did not have low platelets or high ferritin (299.8). My high iron load is what the hematologist was concerned about and she did all the blood work. She also had me do a cat scan and it showed relative enlargement of the caudate lobe liver and spleen in the upper limits of normal. So something is definately going on. I cld be closer to a stage 3 now. It's hard working with both a Gastro and a Hematologist. They are not always on the same page and it is confusing. The Hematologist wants me to get another Cat Scan (which freaks me out..all that radiation) she also saw a lymph node near my kidneys that she wants to make sure isn't enlarged. Soooooo anyway I see the Gastro on Thurs. and I will let him see all the blood work from the Hematologist and see what he has to say. Glad to hear you are doing so much better 144 is much better than 112. Thanks

[GoofyDad]

I started with early cirrhosis and platelets  = 112. They bounced around a bit and a couple times flirted with causing a temporary dose reduction, but it never happened and I SVRed. Each time they rebounded. I also struggled with hemoglobin and white blood cell counts, using growth factor drugs for those.

I switched from a gastro to a hepatology center once I got the cirrhosis diagnosis and I doubt my treatment would have succeeded had I not made the change.

Five years later, my platelets seem to still be slowley climbing out of the toilet, hitting a high water 144 last month. That's my first reading that's wiithin "normal" range,  but not really normal..

[spectda]

In the trial I am currently treating in the requirement for participation was that you have platelets above 100,000 and they are generally conservative in these trials. If you treat privately as many have said you could have a lot lower level of platelets and still treat.

My platelets started at 150,000 at the beginning of tx. they have been 38,000 - the mid fifties during most of tx but I don't think that kind of a drop is typical.  I don't have cirrhosis. I am stage 2-3. no bleeding issues from the low platelets.

You sound like you are at a very safe level to me but of course your doctor will monitor you carefully for this when treating. As Hector mentioned, as long as you stay above 20,000 during treatment and you don't do any roller derby you should be okay.

Good luck
- Dave

[Kathy73]

Hi Renee. I suffered from ITP which is a platelet disorder. My plaletes were in the 40s for years before treating. In order to get a biopsy I had to get gamma globulin infusions to bring my platelets up. This is a short lived treatment to bring them up. I treated with SOC for 48 weeks and my platelets increased. They are in the "low normal" range now. This is not a typical result, but thought you should know. I achieved SVR and am 1 year post treatment.

If you need any help, let me know.
Kathy

[tashka]

Platelets below 150,000 are considered low. Many cirrhotic patients have platelets in 100,000-150,000 range.

[HectorSF]

Hi Renee.

There seems to be a misunderstanding of your blood levels.

Your platelet count is 127,000 norm is 140 - 450 this is only slightly below norm. Low is generally considered below 100,000. Below 100,00 is commonly seem in patienst with cirrhosis. (You say you have Stage 2 fibrosis according to a biopsy). All blood test levels tend to change over time, so if you have other blood tests done, you may find your platelet count within norms.

Your INR of 1.13 is WITHIN NORM on many tests norm 0.9 - 1.2.

What happens during treatment is the true test of how much your platelets drop. I am sure many people on this forum started treatment with a similar platelet count. It is possible to treat as long as your platelet count stays above 20,000 which is nothing you have to worry about I'm sure.

Treatment will not affect your INR level. And it is normal anyway.

It appears that you are nervous about treatment as anyone is but this is not something to worry about. Your doctor would have told you that there is a potential problem with you doing treatment. He wants you to treat with is a good sign.

Good luck with your treatment. Hope SVR for you.
Hectorsf

[Bali05]

The only thing I have ever seen to raise platelets is Pre/Highdose Ribavirin believe it or not.
It has been both my personal experience as well as of a friend of mine.

"Platelet counts increased by an average of 24 mcl (range 9-49 mcl) during ribavirin priming"
http://www.hivandhepatitis.com/2010_conference/aasld/docs/1214_2010_a.html

Maybe you want to mention it to your hepatologist.

just a thought.....

[evangelin]

For what it is worth, (because every-one's reactions are so different) my husband's last  15 month TX attempt, started with platelets at 63.  They stayed in that range the entire 15 months and they were in the high 70's (don't remember the exact number) when he finally was taken off TX.  They hadn't been in the high 70's for several years.  TX just doesn't bother his platelets much, even though he starts so low.  I wish I could say the same for his Hgb.  These things vary dramatically from person to person but as Fl guy already pointed out, you would have to really drop a lot before you'd have a problem.
I hope you have great success,
Ev

[FlGuy]

Lot's of people have successfully treated with starting platelets lower than 127. Even if treatment decreases them further by 75% you ould only be approaching the danger zone (25-30) at which expereinced doctors might suspend or reduce the treatment meds.  But, you should expect that they will not improve in time and realize that, with all the other treatment additives, that platelets might be the most significant limiting factor.  It may be time to consider actually getting rid of the hcv rather than living with it.  You also might ask and experienced hcv doc about the relationship to your spleen (mentioned in another post) and the effects of excessive iron as it relates to treatment.  A hepatologist would be a good choice.