hi, just some thoughts/guesses:
the good (or at least 'better') news is that it's looking like autoimmunity as Londres first suggested.
my guess would be that such a rapid drop in platelets points to action by the immune system. If it were due to lymphoma, the mechanism is that cancer cells in the marrow crowd out normal production - that'd likely be more gradual. But immune cells can wipe them out really fast.
So I'd suggest keeping an eye out for ITP symptoms: purpura, bruising, etc. Her platelet count might get lower every day. Check inside the mouth for bleeding. Ask for a CBC whenever you can - she'd get one before the possible biopsy so ask for a copy as soon as it's done. IIRC, <30K gets to the range of possible worry, <15K more so.
I'd not take fish oil, vit E etc for now (being blood thinners).
Her general body symptoms also seem to point to autoimmunity.
However, keep in mind that ITP or other autoimmunity can *still* be secondary to lymphoma - i.e. deranged B cell cascading mutations.
(Just be aware that autoimmunity can also be drug induced. - an aspect of a drug molecule can make the immune system think there's an invader. That'd probably be rarest possibility of all, though.)
(Also, it could still be virus. E.g. viruses attach to platelets and the immune system then kills the platelet while attacking the virus.)
any history of Hashimoto's thyroiditis? i.e. the immune system attacks the thyroid, can inflame it and cause an initial period of hyperT - but then gradually results in hypoT as the thyroid gets destroyed. (Her bout of weight loss with a BIG appetite is not consistent with cachexia from cancer, but is with the hyperT as you'd mentioned.)
How about Raynaud's history?
The odd thing is the normal ESR followed by the relatively high CRP. Maybe ESR would also have been high if taken on that same day. That would be consistent with the seemingly sudden onset thrombocytopenia. Are there a bunch of CBCs where you can track the decline over the past months?
One question I'd research: to what extent would a negative ANA preclude autoimmunity?
Your advantage is that docs have many patients but *you* have only one patient, so you can oversee things the whole while and maybe help guide dx and tx. Good luck to both of you.
Yes, I can image the nervousness. Well, at least she is feeling better.
Be sure to keep us posted.
Try to take care of yourself too. :)
Update time: Well, yesterday (monday) morning we had her in with a doctor again. We repeated a CBC and her WBC was the same, but this time her platelet count was now low. It had dropped 95,000 over the weekend and was now abnormally low. He ordered a chest Xray which he sent to the Radiologist, who said it is normal. That's great news. He ordered a couple more tests and we received one result today. C reactive protein was elevated 8.1 on a scale of 0-3. We are still waiting for the results of the ANA and CMV. She had an ultrasound today at the request of a general surgeon who will be doing a lymph node biopsy on friday. If the ANA comes back abnormal, we will be referred to Rheumatology and cancel the biopsy for now. If the ANA is normal, we will proceed with a biopsy and be referred to Hemotalogy. The doctor seems to think it is either something autoimmune, like Lupus, or possibly something like Lymphoma. So we are still nervous, but at least she's being treated now. She was prescribed something to help with the pain and something to help her sleep, so she's feeling better today.
Yes, a ESR is an inflammatory marker used to rule out inflammatory diseases, such as Arteritis, Arthritis, Lupus, etc.
Please do take her to the ER if she becomes worse before Monday.
Keep us posted.
Thanks Londres70.
I have a little update. She's still feeling sick, mostly entire body aches, weakness, and fatigue. Tylenol takes the aches away, however. We were able to get the rest of the lab results. TSH is normal. Her Complete Metabolic Panel was all normal. ESR Sed Rate was 5 on a range of 0-20, so also normal. Does a normal Sed Rate rule anything out? We have a follow up appointment Monday with the instructions of going to the ER over the weekend if she gets worse. Thanks everyone.
Speaking from personal (family members) and professional (nurse) experiences, it would be difficult to state it is definitely cancer. She has symptoms that could also indicate an autoimmune disease or even something viral. Yes, the low WBC is very concerning.
Secondly, labs, a bone marrow aspirate, biopsies(Lymphoma) would have to be completed to confirm a definite diagnosis of Lymphoma or Leukemia.
Hang in there until you get some definite answers. I feel for you and your wife.