Raising platelets

[GP7852]

Today is day 61 of sovaldi-olysio.I was negative at 4 weeks.I started at stage 4 cirrhosis.I got in today to see a nurse practicioner who had my 8 week bloodwork.I am still negative but my platelets have gone from 71 to 61 in the last 4 weeks.He told me to get bloodwork done today for them and set me up with the doctor next month.He was concearned about pneumonia.He said even though I have cleared the cirrhosis is causing my platelets to drop.Is there anything on the market that is powerful enough to raise my platelets.I am eating correctly and do not smoke or drink but apparently this is not enough to combat what the cirrhosis is doing.
                                                  Glen

[celtictiger67]

I actually finished interferon,riba 48 week treatment on wed 7th may so I was glad that was over but dr called to say my platletts r at 14 n to go in in a cpl of days for more bloods so I've went from positive to not so positive all other bloods where low or high but nothing to worry about any advice wld be helpful thanks for being a great source of information as I read posts on a regular basis

[Dee1956]

When I treated my platelets fell to about 55.  Several months after finishing tx they came back up.

I was told as long as they did not go below 50 it would be ok.  Of course every doctor is different.

Thank you again Hector, great info as always, Dee

[Sovaldi13Newbie]

I hope your platelets continue to rise as you go on without the disease!

[Sovaldi13Newbie]

thanks so much for your explanations. I don't have cirrhosis, my last biopsy about a year or so ago was stage 1-2. But I had a bone marrow transplant and I too am taking cyclosporin, prednisone (immune suppressants) and my last labs were excellent but my platelets went down to below normal, still not harrowing, but I was a bit concerned. (I'm on Sovaldi Olysio) You're explanations helped me to understand. And they don't even know if I even have Graft vs Host disease (in my liver) anymore. Need to talk to my docs if my platelets get down to much, thanks very much!

[heart_in_the_keyes]

and what Hector is saying about the platelet count is correct.  Please pay attention to his posts.  

And for those who don't know...UND means undetectable.  Not cured.

[heart_in_the_keyes]

People also seem confused on this issue.  The sovaldi / riba hopefully kills off the HCV.  You are UND for the 1st 12 weeks of treatment.  You may or may not be SVR.  You will have to wait until you they do further blood tests to see if you are really SVR.

They should be taking blood tests while you are on s / r to check things like your platete count etc.  

If you have a compensated liver ....and you do go SVR ....damage should stop  and your liver should start regenerating unless there are other factors that are damaging your liver, (alcohol, cigarettes, bad diet, etc.)

If you have a decompensated liver...and you do go SVR...damage should stop but your liver because of it's decompensation will not, will not, regenerate itself. Period.

Sovaldi/Riba or any combination are to kills for the HCV.
They do not cure cirrhosis.  

[Livelife777]

Hi Glen.      Seems we are in the same boat.    I just asked this question the other day about my platelets.     They dropped when treatment ended.    Was not expecting that but with cirrhosis you never know.    Figure we are all headed in the right direction and with time hopefully we will see an uptake.    Guess the best way to deal is, not worry and try to stay as healthy as we can.   For me understanding why it happens gives me more peace of mind.     Kim

[Dee1956]

Thank you so much for the great explanation, it was really helpful.
Of course all of your answers are helpful.
I always learn from them.
I just got one of my first "normal" platelet levels, on the low side of normal but still normal.
I am wondering how much the Ibuprofen I took lowered my platelets before my back surgery

Take Care

[nan535]

Thanks  for your response. Yes, I agree that there are no easy answers or explanations for post liver transplant patients. We are seeing that first hand.

I do know now that the Hep C treatment is having a positive impact on all of his lab numbers week after week.  So his liver must be improving as are his kidneys. More importantly, now that the HE episodes are over (see other thread post) he is starting to feel and look better.

I am just grateful he is able to continue on treatment now and time will tell where this all ends up.

Thanks, Howie.  Wishing you well as you continue to recover from transplant.

Nan

[GP7852]

Thanks Hector,I have one more question for you,and that's because I am certain you know more than the nurse practitioner I saw yesterday.I have gotten the flu and was told that it is not from the sovaldi-olysio.I got a prescription for Tamiflu to treat it.Is the Tamiflu safe to take with these meds.The nurse also said that I don't have to treat the flu but it is really beating me up,especially being so stuffed up that I cant breathe out of my nose which makes it impossible to sleep.I have to call out sick from work tonight because of exhaustion from 0 sleep last night.
                                            Thanks   Glen

[HectorSF]

Glen, it is not an never ending battle if you curing your hep C before needing a transplant, but it takes time and patients. Curing hep C is step 1. Reversing cirrhosis ha[[ens as a result of stopping the injury to your liver from viral replication that may take years to fully happen. Take it one step at a time. That is all you can do.  

If there was a shortcut none of us would have needed transplants or died because of liver disease or liver cancer.

Realize that curing hep C before irreversible liver disease has developed is the goal and the best option for a good prognosis.

For us with liver transplants our lives are changed for ever.

Hector

[HectorSF]

Nan,

There are many factors involved in the production of platelets not only the spleen. Even in patients with cirrhosis, and no splenomegaly they have lower platelet counts. Bone marrow. issues (for example like I am now experiencing because of my immunosuppression meds) and the presence of antibodies against platelets also contribute to thrombocytopenia (low platelet counts). So nothing with liver disease is simple. So my explain was a basic simplified view.

I was speaking about pre-transplant patients with cirrhosis. In post-transplant it is a different environment. Hep C treatment and many other things are different for us. Many more variables due to immunosuppression, other conditions and illnesses, etc. etc. etc. Too many to mention in general.

" can we assume then that the inflammation of the spleen is being reduced allowing platelets to get through and that blood is flowing better through the liver? "
First, there is no "inflammation" of the spleen. It is portal hypertension caused by cirrhosis (the increase the blood pressure inside the vessels of the spleen). The spleen gets enlarged due to the back pressure in the portal vein. Back-pressure will cause spleen to increase in size because the blood gets pooled there.

Imagine the portal system as a plumbing network of pipes, the spleen would be at the end of the pipe, like a sponge. When there is a block in the pipe (scarring in the liver -portal hypertension - blocks blood flow), the back pressure will cause the sponge to soak up more water, and in the process expand the sponge.

I believe your husband is on Sovaldi? Sovaldi and ribavirin? Anyway Sovaldi in some patients can raises platelet counts during treatment. (It happened to me).

So increased platelet count really nothing to do with the spleen. Why do platelets rise? I don't no if anyone knows for sure. Probably more likely bone marrow changes or antibody changes. But cirrhosis or portal hypertension won't be reduced within weeks of hep C treatment. Even us transplant patients with a new liver still have enlarged spleens and many times lower platelet counts. It usually can take many years for our splenomegaly to return to normal.

Sorry this is complex especially as I am trying to address the issue for both pre and post transplant cirrhosis. Maybe an impossible task.

Hector

[GP7852]

To heartinthekeyes
I have started taking some new fruits and vitamins in hope of getting my platelet count up.Papaya and papaya extract pills.Lots of tomatoes,oranges,apples.Along with leafy lettuce and lots of broccoli.I too have been dizzy along with a 2 day nosebleed and this I believe is due to my platelets.I thought that getting negative would end my problems but I was unknowledgable and naïve.As great as it is to be negative I now realize I have a big battle still ahead of me.As I was told today by the nurse practicioner I have to get ultrasounds twice a year to make sure there are no tumors because of the cirrhosis.I guess this is a neverending battle.
                                 Good Luck     Glen

[heart_in_the_keyes]

thank you Hector....great explanation.

[GP7852]

Thanks for sharing your expertise Hector.You made it sound like I might be better off without my spleen.I was concearned because yesterday I had my first nosebleed since I started treatment.They were pretty frequent before I started treatment and I was hoping that after I cleared I wouldn't have to deal with them anymore.I did google things to help raise my platelets and they were things I was mostly already doing like plenty of fish,leafy stuff,vitamin c and fresh fruit.I just went to the market and got some papaya and some papaya extract pills,they said it was beneficial.I was wondering if anybody had any more suggestions to help raising my platelets so I can get rid of those awful nosebleeds.They are very embarrassing when I have them at work in front of the public and my co workers.
                                    Thanks   Glen

[nan535]

Great explanation, Hector.
So if the platelets of a person on treatment increase significantly. can we assume then that the inflammation of the spleen is being reduced allowing platelets to get through and that blood is flowing better through the liver?

Example:  140 (before treatment) rising to 240  (after 10 weeks on treatment)

Nan

[HectorSF]

A platelet count of 61,000 is fine. Many people with cirrhosis have platelet counts in the 60s and 70s for years. All people with cirrhosis and portal hypertension have lower than normal platelet counts. <140,000

Here is how it works...

Blood flows from the spleen...through the portal vein...then through the liver. Scar tissue in the liver (cirrhosis) can interfere with that blood flow, causing pressure to build up in the portal vein (portal hypertension), and the spleen to enlarge (splenomegaly). As the spleen enlarges, it traps platelets. (The amount of platelets in the bloodstream is reduced because the spleen is busy trapping them). So usually---people with cirrhosis end up having a problem with portal hypertension and an enlarged spleen, and a reduced platelet count in the bloodstream. As time goes by, the liver may try to repair itself by growing new cells. If there is a lot of scar tissue already present--- the new cells grow between scar tissue (and result in abnormal nodules). (The nodules and scar tissue can further interfere with blood flow through the liver). So over time people with advanced cirrhosis can end up having a problem with more and more abnormal nodules and scar tissue forming...which interferes even more with blood flow through the liver.....which makes the spleen continue to enlarge....and the platelet count continue to drop.

Platelets in the blood causes your blood to clot if a blood vessel is cut. They have no affect on how you feel.

If a person's platelets count goes down below 25,000 is there may need to intervention. Intervention is only a temporary fix. Platelets will start to drop again a day or two after treatment. The only treatment is either a platelet transfusion or drugs that can raise platelets. You need neither.

Pneumonia (a bacterial infection) or any type of infection is unrelated to platelet counts. Having cirrhosis or having low WBC means a person has a compromised  immune system and may be more likely to develop infections.

Good luck with being cured!

Hector

[heart_in_the_keyes]

good question...like the answer too...am at same stage and sovaldi working but platelets are really low and I am dizzy all the time...have been doing so good...this dizziness started about a week ago.