need some answers

Hi I am 32 yrs old and I recently went to my doctor for headaches not sleeping and some random bruising on my arms and legs. They did blood work gave me something to help me sleep. On Monday I called to see if my labs were back and they were and they had to have the nurse call me back. They did a cbc, checked my cholesterol, thyroid, iron, and metabolic. She told me every thing came back fine but my platelet count was low. 45 to be exact! I know that normal is between 150-450. She told me that 2yrs ago mine were 250. I have also not been sick nothing else was off. They told me they had scheduled me an appt. with an Hemotolgist /oncologist for oct.6th. I'm just not sure what to expect and really scared. any thoughts would be greatly appreciated. I have never really been sick in my life. I have 4 healthy babies and have led a normal non illness life. HELP!!!!!

Chels04, welcome! You will find a lot of support and information at this website.

First off, don't let the "Oncologist" label scare you. A large portion of hematologists work in oncology because there are so many cancers that affect the blood, but adult platelet disorders are usually autoimmune disorders, especially when other bloodwork comes back normal.

Second, a low platelet count can be brought on by temporary illness or medications, and might resolve by itself.

Third, a platelet count of 45 is not dangerously low. Some people on this site live normal lives with platelets in the single digits, and many don't treat unless their platelets go below 20 or 30, unless they are anticipating surgery for other reasons.

That said, it is important to get checked out and rule out all other possibilities. ITP - immune thrombocytopenic purpura - is diagnosed by elimination. There is no actual test for it.

Be sure to educate yourself thoroughly before your hematology appointment, so that you will be able to advocate for yourself, and so that you can better determine whether the doctor really knows platelet disorders (most do not!) There is a lot of excellent information on this website.

rob16,

thank you! My md nurse did say that they believed it to itp. With that said, what should I expect at this hemo appt.? I have been reading about itp like crazy!

All I can tell you is what my wife, Ellen, experienced with her first visit. Blood draws were scheduled ahead of the appointment. The hematologist had already looked at blood slides for any abnormalities (there were none). She indicated that other tests were being run, but her preliminary diagnosis was ITP, which she took a long time to explain in depth.

The doctor ordered some immunizations which are recommended before a splenectomy - just in case that became necessary. Ellen's platelets had fallen into the 20s, so she was prescribed a course of steroids. In her case, high dose dexamethasone was prescribed - 4 daily doses of 40 mg prednisone. (This treatment may or may not apply to you at your platelet count, and varies between doctors.)

A follow-up appointment was scheduled, and Ellen left with a handful of printed information.

thank you so much rob16! this is a lot to take in! I have read so many different things and trying to figure out what to expect when I get there!.

Hi Chels - I'm glad you found us.

My advice - be careful what you read. There are some really good articles about ITP and there are some pretty bad ones. Anything that is old and outdated will not apply at this time, things have changed a lot. There are also some articles that have incorrect information. If you are not sure about something, just ask. Some of the general information about ITP on some web sites is wrong.

As for what to expect; there are two kinds of doctors. One that is calm and easy-going and one that panics and freaks the patients out. A calm one is better. If your counts are still the same at your appointment, he should just suggest monitoring you at this point. Some Hemo's like to do a bit of testing, but it's generally not necessary. Most of the time, a doctor can tell it's ITP by looking at the blood smear and by asking about any odd symptoms that the patient may have. If you've experienced weight loss, fevers, night sweats, pain, etc., then there would be cause to look further. If not, chances are it's just ITP.

Thank you Sandi! I am having bruising, bleeding when I brush my teeth, headache and tire, not sure of all of those pertain to my count or not. I know the nurse said non of my other labs were off except the platelets. She didn't go into much detail just said I needed to see the hemo. They didn't order another blood draw so I'm guessing when I get there they will do one. I have read about people having to have bone marrow checks. I'm guessing this is gonna depend on what my hemo suggests right? Also everyone seems to have views on what is a critical number and what isn't. Very confusing and how will I know if they are dropping fast, lol. thanks for all your help.

Most of your symptoms are common ITP complaints. Bruising and bleeding is typical, headaches and fatigue vary from person to person.

Some doctors do a bone marrow test and some do not. According to protocol, it's not necessary to diagnose ITP unless the patient is over 60 years old. Sometimes it's a good idea to have it done prior to splenectomy or for someone who is unresponsive to all treatments. Otherwise, it's an invasive procedure that isn't as bad as it sounds.

Most doctors agree that under 10 is critical. However, many people have had counts that low and do just fine. The guidelines suggest treating at about 30, but some go lower than that. That is the hard part about ITP; trying not to panic when counts are low. Two things determine what happens then. One - the doctor's response. Some doctors hospitalize and some tell their patients to go to work and live life normally. Two - symptoms. Some people experience bleeding at higher numbers than others. Sometimes you don't know if counts are dropping fast, going by symptoms is a pretty good indicator because even if counts are low and there are few symptoms, most people are fine. Bruising and petechiae are the most common symptoms, but can also include bleeding gums, nose bleeds, mouth blood blisters and heavy periods. A few small bruises are generally nothing to worry about, especially if you remember bumping yourself. Sometimes ITP bruises can be spontaneous huge, purple-black bruises. Those are nasty. Usually if you see those, counts are low.

Things to know about ITP: It is manageable for most people. After the initial shock and fear, you can live life normally. Treatments disrupt life a bit and side effects are not pleasant, but not so horrible that you can't function (although steroids bring you close)! ITP can go into remission at any time and is not always a lifetime gig.

One more thing, Chels, you mentioned headaches: if nobody has told you yet, you must stay away from aspirin, ibuprofen, naproxen, etc., as these can interfere with your platelets and increase your tendency tyo bruise and bleed.

Thanks everyone for you information. I will let you know what I find out of my appointment.