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Possible Bone marrow bx for WBC low-2.8, Platelets 8,000 today- got IVIG
- Cindy1
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- For 7 months, platelets crashed (as low as 1,000) every 10 days between IVIG treatments. I got cured 10/2017 after taking parasite destroying medicine and Rife US tx.
1. Has anyone had a bone marrow biopsy? If so was it for low WBC count and at what count? Did you get sedation?
2. On Promacta 50 mg since 8/6, Upping Promacta today to 75mg. If that dosen't help will probably get bone marrow biopsy and then dr said I need to decide if do nplate vs Rituxin. I am thinking Nplate any thoughts?
3. Stopping CDB cause I am wanting to have a true WBC count next week.
Thanks,
Cindy
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- Sandi
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- Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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- mrsb04
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- ITP since 2014. Retired nurse. My belief is empower patients to be involved as much as possible in their care. Read, read, read & ALWAYS question medics about the evidence base they use.
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- Sandi
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- Cindy1
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- For 7 months, platelets crashed (as low as 1,000) every 10 days between IVIG treatments. I got cured 10/2017 after taking parasite destroying medicine and Rife US tx.
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- Cindy1
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- For 7 months, platelets crashed (as low as 1,000) every 10 days between IVIG treatments. I got cured 10/2017 after taking parasite destroying medicine and Rife US tx.
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Why did they do your BMB. Low WBC?
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- Cindy1
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- For 7 months, platelets crashed (as low as 1,000) every 10 days between IVIG treatments. I got cured 10/2017 after taking parasite destroying medicine and Rife US tx.
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- Sandi
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- Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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- Hal9000
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- Give me all your platelets and nobody gets hurt
For me, that side of my, ahhh, buttocks hurt for a couple of weeks to sit on. Literally, a BMB is a real pain in the as.
75mg Promacta? WELL ITS ABOUT TIME !
Thinking about what to do if Promacta fails is good planning. As for Rituxan, since you seem to have a steroid (and IVIG) response, that seems plausible. As I and others will point out (coughSandicough) there are significant cautions with it. If you go onto Nplate getting to a stable count is a bit of a question mark if emergency IVIG treatments enter the picture.
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- Sandi
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- Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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- Cindy1
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- For 7 months, platelets crashed (as low as 1,000) every 10 days between IVIG treatments. I got cured 10/2017 after taking parasite destroying medicine and Rife US tx.
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It is all so confusing to me. I tried to google what parameters indicate a bone marrow bx with little success.
Have a good Sunday!
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- Sandi
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- Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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With ITP, protocol states that a bone marrow biopsy should be done if a patient is over 60, if they do not respond to treatment and sometimes prior to splenectomy. If other counts are abnormal (reds and whites), that is also cause to consider a BMB.
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- Cindy1
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- For 7 months, platelets crashed (as low as 1,000) every 10 days between IVIG treatments. I got cured 10/2017 after taking parasite destroying medicine and Rife US tx.
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I just thought to cut and paste so you could see all my numbers today. They are wanting to schedule a BMB.
Here are my questions...
1. Platelets only went from 8,000 Friday to 15,000 today. All I got Friday was IVIG. Do you have any thoughts on what could be causing the slow climb?
2. How does IVIG effect bllod numbers? MY WBC were down from 2.8 Friday. Could that be due to IVIG Friday because that is just what happened when I went to Mayo? IVIG Friday and 1.8 WBC Monday.
3. Do you think doctors need to do the BMB? They have nurse practioners and PAs doing them.
Todays LABS in case it is helpful to you.
White Blood Cell Count 1.8 10*9/L 4.0 - 11.1 10*9/L
Red Blood Cell Count 4.51 10*12/L 4.18 - 5.64 10*12/L
Hemoglobin 12.9 g/dL 12.1 - 16.3 g/dL
Hematocrit 39.0 % 35.7 - 46.7 %
Mean Corpuscular Volume 86.5 fL 80.0 - 100.0 fL
Mean Corpuscular Hemoglobin 28.6 pg 27.5 - 35.1 pg
Mean Corpuscular Hemoglobin Concentration 33.1 g/dL 32.0 - 36.0 g/dL
Platelet Count 15 10*9/L 150 - 400 10*9/L
Red Cell Distribution Width CV 13.3 % 11.7 - 14.2 %
Segmented Neutrophil Percent 32.3 % %
Lymphocyte Percent 40.9 % %
Monocytes Percent 22.2 % %
Eosinophils Percent 2.3 % %
Basophils Percent 2.3 % %
Immature Granulocytes Percent 0.0 % %
Neutrophils Absolute 0.6 10*9/L 1.8 - 6.6 10*9/L
Lymphocyte Absolute 0.7 10*9/L 1.0 - 4.8 10*9/L
Monocytes Absolute 0.4 10*9/L 0.2 - 0.9 10*9/L
Eosinophils Absolute 0.0 10*9/L 0.0 - 0.4 10*9/L
Basophils Absolute 0.0 10*9/L 0.0 - 0.2 10*9/L
Immature Granulocytes Absolute 0.0 10*9/L 0.0 - 0.05 10*9/L
Thanks for any insights.
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- Sandi
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- Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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I don't know the answers to your questions. I can only answer one. Yes, I think you should do the bone marrow biopsy if your doctor is recommending one.
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- anon
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- Cindy1
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- For 7 months, platelets crashed (as low as 1,000) every 10 days between IVIG treatments. I got cured 10/2017 after taking parasite destroying medicine and Rife US tx.
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Just rereading posts. Could you tell me what significant cautions you have with Rituxan?
Thanks,
Cindy
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- Hal9000
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- Give me all your platelets and nobody gets hurt
There is lots of info out there on the subject. Wikipedia is as good a place as any to get started. As I recall it is 'PML' and 'JC' virus that are the big threats.
en.wikipedia.org/wiki/Rituximab
But this article seems the most comprehensive and the one most capable of scaring one silly. Perhaps I'm a numbers person and it was the numbers that scared me. Lots of numbers in it. Also realize that one would want to read it from the context of treatment for ITP - it covers a lot more. As I recall the biggest take away from the article is that one doesn't want to be taking more than just Rituxan (eg steroids) when taking Rituxan.
www.iwmf.com/sites/default/files/docs/Rituximab-Associated_Infections-Seminars_in_Hematology.pdf
You might want to read through this thread on hypersensitivity reactions too, just to be fully informed.
pdsa.org/discussion-group/7-treatment-general/29710-identifying-hypersensitive-reactions-to-rituxan.html#59609
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