My Platelets

[Lukey]

Is this good? I seem to have platelets being 253.

[Lynn K]

Minimum normal platelets are 150. Platelets levels begin to be reduced as a consequence of cirrhosis which in turn will cause portal hypertension because of increasing liver scarring. This in turn causes the spleen to become enlarged and begin to sequester platelets.

I had cirrhosis for 5 years before my platelet counts reduced to below normal. Before I treated they were in the 80 to 90 range. Doctors don’t usually become concerned until platelets fall below 50 and if they get as low as 30 patients may need to have platelet transfusions.

Low platelet counts is the reason we with cirrhosis experience easy brusing and why we are at increased risk of having dangerous bleeding events and need to avoid NSAID pain relievers like Aleve, Motrin, Aspirin and why we are advised to only take Tylenol for pain management as Tylenol does not increase the risk of bleeding for patients with ESLD.

Your test reports your platelet count as “N” meaning normal. A normal platelet count is an indication you likely do not have cirrhosis induced portal hypertension which agrees with your Fibrosis score.

[Lynn K]

A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Having more than 450,000 platelets is a condition called thrombocytosis; having less than 150,000 is known as thrombocytopenia.


Your platelet count is 253,000 per micro liter so just slightly below exactly mid range normal

[Lukey]

Thank you Lynn.

[Type0Negative]

My Platelets are high so as my INR. I read that it can be due to inflammation.

[Lynn K]

As far as I know a high platelet count is good INR is how long it takes blood to clot so a high number for INR means you are at risk of bleeding.

It seems to me they should rise or fall together.

My INR at 1.1 is the reason I have a MELD score of 7 if it was lower my MELDwould me the minimum score of 6.

“A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Having more than 450,000 platelets is a condition called thrombocytosis; having less than 150,000 is known as thrombocytopenia. You get your platelet number from a routine blood test called a complete blood count (CBC).”

Is your platelet count above 450?

Mine is low at 110 a symptom of cirrhosis and portal hypertension.

“A high platelet count may be referred to as thrombocytosis. This is usually the result of an existing condition (also called secondary or reactive thrombocytosis) such as: Cancer, most commonly lung, gastrointestinal, ovarian, breast or lymphoma. Anemia, in particular iron-deficiency anemia and hemolytic anemia.”

I am not seeing an elevated platelet count above 450 being associated with inflamation. Most often it is associated with several forms of cancer.

[Lynn K]

“PT is measured in seconds. Most of the time, results are given as what is called INR (international normalized ratio). If you are not taking blood thinning medicines, such as warfarin, the normal range for your PT results is: 11 to 13.5 seconds. INR of 0.8 to 1.1.”

“When the INR is higher than the recommended range, it means that your blood clots more slowly than desired, and a lower INR means your blood clots more quickly than desired.”

So not associated with inflammation

High INR:

“Blood that clots too slowly can be caused by:
Blood-thinning medications.
Liver problems.
Inadequate levels of proteins that cause blood to clot.
Vitamin K deficiency.
Other substances in your blood that hinder the work of clotting factors.”

[Nina Mae]

My platelet count is 165
My INR is 1.4

What is the significance of this scenario where platelets are normal but INR is high?

I'm up here in BC, Canada and they use different reference measurements.  For example, my hemoglobin is 108 gl (reference range is 115-155).  What measurements are used in USA so maybe you guys can understand what these numbers are that I'm posting (unless it's the same after all).

Canada also uses 'umol/L' for bilirubin (total and conjugated) and 'U/L' for numerous tests as well as 'g/l'.

What's puzzling me also is my Alkaline Phosphatase which my most recent result was 230 U/L with a reference range of 35-120.

What's up with that...

[Lynn K]

It is best to compare to the reference ranges used by your lab so what we get is of little value. Your platelet count is in normal range as far as I know the low end should be 150 I assume the reference range is the same on your lab report.

More things effect your INR other than platelet count. My platelet count was as low as 80 but my INR was and is 1.1

From the Mayo Clinic:

“What can cause low INR?
Blood that clots too slowly can be caused by:

Blood-thinning medications.
Liver problems.
Inadequate levels of proteins that cause blood to clot.
Vitamin K deficiency.
Other substances in your blood that hinder the work of clotting factors.”

Your hemoglobin is just slightly low.
From the Mayo Clinic

“In many cases, a low hemoglobin count is only slightly lower than normal and doesn't affect how you feel. If it gets more severe and causes symptoms, your low hemoglobin count may indicate you have anemia.”

“Causes
By Mayo Clinic Staff
Normally low hemoglobin counts

A slightly low hemoglobin count isn't always a sign of illness — it may be normal for some people. Women who are pregnant commonly have low hemoglobin counts.

Low hemoglobin counts associated with diseases and conditions

A low hemoglobin count can be associated with a disease or condition that causes your body to have too few red blood cells. This can occur if:

Your body produces fewer red blood cells than usual
Your body destroys red blood cells faster than they can be produced
You experience blood loss
Diseases and conditions that cause your body to produce fewer red blood cells than normal include:

Aplastic anemia
Cancer
Certain medications, such as anti-retroviral drugs for HIV infection and chemotherapy drugs for cancer and other conditions
Chronic kidney disease
Cirrhosis (scarring of the liver)
Hodgkin's lymphoma (Hodgkin's disease)
Hypothyroidism (underactive thyroid)
Iron deficiency anemia
Lead poisoning
Leukemia
Multiple myeloma
Myelodysplastic syndromes
Non-Hodgkin's lymphoma
Vitamin deficiency anemia
Diseases and conditions that cause your body to destroy red blood cells faster than they can be made include:

Enlarged spleen (splenomegaly)
Hemolysis
Porphyria
Sickle cell anemia
Thalassemia
Vasculitis (blood vessel inflammation)
A low hemoglobin count can also be due to blood loss, which can occur because of:

Bleeding from a wound
Bleeding in your digestive tract, such as from ulcers, cancers or hemorrhoids
Bleeding in your urinary tract
Frequent blood donation
Menorrhagia (heavy menstrual bleeding)
Causes shown here are commonly associated with this symptom. Work with your doctor or other health care professional for an accurate diagnosis.”

My lab says 11.1 to 15.9 is normal HGB mine is 14.0 sounds like similar to your scale just moved the decimal point.

My lab uses mg/dL 0.0 to1.2 for bilirubin total

For  alkaline phosphatase my lab uses 39-117 IU/L my most recent was 66

From lab tests online

“High ALP usually means that either the liver has been damaged or a condition causing increased bone cell activity is present.

If other liver tests such as bilirubin, aspartate aminotransferase (AST), or alanine aminotransferase (ALT) are also high, usually the increased ALP is coming from the liver. If GGT or 5'-nucleotidase is also increased, then the high ALP is likely due to liver disease. If either of these two tests is normal, then the high ALP is likely due to a bone condition. Likewise, if calcium and/or phosphorus measurements are abnormal, usually the ALP is coming from bone.

If it is not clear from signs and symptoms or from other routine tests whether the high ALP is from liver or bone, then a test for ALP isoenzymes may be necessary to distinguish between bone and liver ALP.

ALP in liver disease
ALP results are usually evaluated along with other tests for liver disease. In some forms of liver disease, such as hepatitis, ALP is usually much less elevated than AST and ALT. When the bile ducts are blocked (usually by gallstones, scars from previous gallstones or surgery, or by cancers), ALP and bilirubin may be increased much more than AST or ALT. ALP may also be increased in liver cancer.

ALP in bone disease
In some bone diseases, such as Paget's disease, where bones become enlarged and deformed, or in certain cancers that spread to bone, ALP may be increased.

If a person is being successfully treated for Paget's disease, then ALP levels will decrease or return to normal over time. If someone with bone or liver cancer responds to treatment, ALP levels should decrease.

Moderately elevated ALP may result from other conditions, such as Hodgkin's lymphoma, congestive heart failure, ulcerative colitis, and certain bacterial infections.

Low levels of ALP may be seen temporarily after blood transfusions or heart bypass surgery. A deficiency in zinc may cause decreased levels. A rare genetic disorder of bone metabolism called hypophosphatasia can cause severe, protracted low levels of ALP. Malnutrition or protein deficiency as well as Wilson disease could also be possible causes for lowered ALP.”

So basically what ever is going on could be many different things so best to discuss with your hepatologist for a proper diagnosis

[Nina Mae]

Hi Lynn K,

Thank you so very much for all that info.  I know it had to take a great deal of work to copy/paste let alone research this for me and I am ever so grateful.

I really need to slow down with this...I need more lab results to follow trends myself and not depend on the nurse to tell me that the numbers are going in the right direction.

You're doing well and that's because of your the knowledge you, yourself, obtained and being your own advocate.  Knowledge is our best offense...when I don't understand what is going on precisely and why, I feel vulnerable because without knowledge, I'd be forced into giving in and following what others may think is the right thing for me.

I think it will be easiest if I want to discuss a blood test(s), to include the reference range used instead of trying to convert to different types of measurements

Tomorrow marks Week 4 and bloodwork.  Hep C nurse emailed me after the weekend last time. 

How it works here in Vancouver (at least, in my experience so far), the hepatologist sets the patient up for requesting approval for DDA's from Province.  Once Province approves tx, you're placed in the Hep C Program with a specific Hep C nurse.  Hep C nurse, I think, sets up the individual tx in conjunction with hepatologist's approval.  While in the program, during my 12 weeks on Epclusa/Ribavirin, I go through the nurse and not the hepatologist for everything liver related; if I need to see hepatologist during tx, she'd have no problem with it.  From what I experience now, the nurse dispenses the initial month's dosages, explains your disease and prognosis.  I don't reach out to her unless I am experiencing a side effect that is not listed (ie Nadolol saga).  Nurse will continue monitoring my bloodwork for at least a year and I'm to be screened every 6 mos for HCC.

I have an appointment tonight with my GP and now I think she will be the one that will help me translate these results as she has the baseline results to compare to (I didn't get them from nurse but I'll get them from GP).  And I suppose anything like the cream that helps with itching that lporterrn recommended and stuff like that.

In any event, thanks again, Lynn K, for your extraordinary help and support as usual.

And thanks for reading this winded and boring post.

Have a great day, everyone!  Feel good and if your weather is copperating get out for a lovely walk!