Thrombocytopenia is sometimes described as a platelet count lower than 50,000. So you're not there yet and hopefully you won't get there. I sincerely doubt that you are close to needing a transfusion. With some surgeries there are doctors who prefer to transfuse blood or platelets in a patient with low platelets prior to surgery so, should you require a surgical procedure, you might need to get transfused.
The risk of a low platelet count is bleeding. I would be interested in knowing what your prothrombin time is - clotting time or INR. Platelets are one factor in clotting and at one point I had a pretty low platelet count (30,000) but my clotting time must not have been alarming because my doctors weren't concerned. I have read that there is a risk of internal bleeding with a platelet count under 10,000 but you're a very long way from worrying about that.
I'd guess that your low platelet count was attributable to at least 2 causes. You mentioned splenomegaly and I agree with you that your enlarged spleen is sequestering platelets. Your previous alcohol intake may also have impaired your platelet production as well as impacted the quality and lifespan of your platelets. I believe that a bone marrow test would indicate whether you're producing an adequate number of platelets and the fitness of those platelets. I question whether a test like that would be appropriate since it seems as though your platelet count is directly associated with your liver condition.
I don't know much about alcohol induced liver damage but it seems reasonable to believe that if you are no longer assaulting your liver with alcohol that you liver will not deteriorate further - that it should remain stable - if not improve. I sincerely hope that is the case Randy.
The bottom line is that I think you're platelet count, though low, is not dangerously low and shouldn't be a reason for anxiety. Of course, you know that I'm just a patient so my opinion should be taken in that context.
Good luck and keep doing what you've been doing.
Mike thank you again for helping me. I always value your opinion. Over the course of the past two years I have seen my platelets go up and down. 60 is the lowest thus far. I’m sure that diet plays a role in this as well as the portal hypertension. Most of my enzymes have stabilized although some are out of range such as bilirubin, AST, GGT, platelets and ammonia.
I am tested every three months and I record and chart all the information. Abstinence from alcohol has not been any problem for me. As you are aware cirrhosis is a terminal illness so progression can never be completely stopped but can be slowed enough for me to survive to my full life expectancy providing too much damage has not occurred. I monitor these results and take the necessary steps to at least keep them where they are.
My last test result showed a drop from 72 to 60 that is why I had the concern. As you probably know as my liver condition worsens the portal hypertension will increase and blood flow will back up into the spleen causing it to enlarge even more. As the blood flows through the spleen many platelets will drop to the bottom and remain trapped hence giving me the low platelet count. The larger it becomes the more of a drop I should expect. My portal hypertension is managed using a blood pressure medication but can’t be lowered any further.
My last INR test was 1.1 on 10-17-11 the same as it was nearly two years ago. So I’m thankful for that. Bilirubin has jumped to a 2.8 from a 2.3 at one point I was jaundice at 3.5. I haven't found any way to control it through diet or exercise. Improvement of the health of my liver is the only is the only way I know of to decrease my bilirubin to a normal range.
I think at this point my best bet is going to be foods high in antioxidants to help my liver function. However I am relocating from El Paso to Nashville by the end of the month. I’m a little nervous about leaving my current Gastrologist but I will see one out there and a hematologist. Vanderbilt transplant center is there in Nashville so I'm hoping that if the two corroborate I can get help and guidance to get these problems more manageable. I have often thought that a nutritionist or at least testing for vitamin deficiencies could play a key role. Thank you very much for your help Mike and I will do some more research concerning healthy platelets and cirrhosis. Just to see what I can work out.
Im not sure if I have sent you a copy of my charted labs but if you think it might be helpful I sure would be appreciative of any advice you have to offer. Thank you again my friend! Take care.
I came across this:
What is a normal platelet count?
Posted: May 08, 2011
Matthew Hoffman, MD
Platelets are the tiny blood cells that help stop bleeding by binding together to form a clump or plug at sites of injury inside blood vessels.
A normal platelet count is between 150,000 and 450,000 platelets per microliter (one-millionth of a liter, abbreviated mcL). The average platelet count is 237,000 per mcL in men and 266,000 per mcL in women.
A platelet count below 150,000 per mcL is called thrombocytopenia, while a platelet count over 450,000 is called thrombocytosis. Platelets seem to have a large backup capacity: blood typically still clots normally as long as the platelet count is above 50,000 per mcL (assuming no other problems are present). Spontaneous bleeding doesn’t usually occur unless the platelet count falls to 10,000 or 20,000 per mcL.
Platelets are constantly being produced in the bone marrow. A low or high platelet count is not often a problem by itself, but can frequently be a sign of another medical condition. For this reason, high or low platelet counts require additional medical attention.
Posted: May 08, 2011
I looked at your labs Randy. One thing that puzzles me is you had a normal bilirubin of 2 occasions. I wonder why your bilirubin went from 3.5 to 1.0 in 3 months. That looks odd to me. Have you ever suffered from gallstones?
I wish I could be of more help but it seems as though you've got a good handle on things.
I have gallstones and possibly some gravel. Is there any relationship in this and the bilirubin? I have heard the gravel is worse since its more likely to cause blockage in the bile ducks.
I undergo an ultrasound of the groin and abdominal area every 6 months to watch to view the texture of my liver, checking for ascites (none), measurements of the spleen, kidneys, umbilical hernia and to watch for cancer since cirrhotic patients are a good candidate.
The ultrasound results also continuously mention thickening of the walls of the gallbladder, and so I’m not sure if this could lead to anything more serious.
I was also puzzled and at first excited about my bilirubin being in a normal range and have been clueless as to what I did different on these two occasions. I have often wondered if it were possible the testing was in some way inaccurate. If this is not the case then it at least tells me It is possible my liver function can still be improved. I just have to keep working at it. Reading and learning from people like yourself play a key role rehabilitation. Two years though I thought this would have stabilized by now or shown a decline but things still seem uncertain. I’ll keep watching, learning and making necessary changes though Mike.
Again thank you, Randy
It's possible and not uncommon for gallstones to block the bile duct which can result in an increased bilirubin test result. If this was the case I would expect it to show up on ultrasound examination. I'm no expert but when I saw your bilirubin go from 3.5 to 1.0 I wondered whether you may have passed or dislodged a stone which allowed your bilirubin to flow unobstructed and thereby reduced the bilirubin in your blood. I'd think that your doctor(s) would be looking at that possibility but I have also learned to very rarely trust anyone. Frequently it's the fundamentals that get overlooked.
The good thing is that if, by chance, gallstones are a contributing factor removal of your gallbladder would resolve the problem. It's usually an out patient procedure.
With an obstruction of the bile duct the ALP is usually significantly elevated unless the blockage is slight or intermittent. Your Alkaline Phosphatase doesn't suggest an obstruction but again, I am no expert. I'm just thinking out loud here.
Maybe run it by your doctor and get his take.
This is very good information Mike. Once I’m settled in Nashville this will be the first thing I inquire about with my Gastrologist and Hepatologist. Amazing something like this can now be outpatient surgery.
The gallstones were diagnosed shortly after my cirrhosis was, so I think they were developed at a time when my the health of my liver was much worse so I wouldn't expect further problems after the extraction.
I don’t know if they would consider the surgery since due to cirrhosis my immune system is compromised. At one point I was scheduled for corrective surgery for my umbilical hernia by my general doctor, once I mention this to my gastro he scheduled an emergency MRI and discovered I was in no danger of strangulation of the intestine and had me cancel the surgery. Although the procedure is simple the risk of infection can be dangerous. This is the same reason I have never been biopsied but I guess the MRI and ultrasounds are specific enough. I haven’t been sick with cold or flu in the past two years so I don't think it’s as vulnerable as he suspect but better to be safe.
Good job thinking out loud though Mike, I like that about you! ha ha Thank you for your help sir, I hope all is well on your end.