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TOPIC: Wife - Low Platelets

Wife - Low Platelets 1 month 8 hours ago #66372

  • thomasjohnwood
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Hello everyone,

Firstly, a big thank you to everyone who came before my wife and I. By sharing your stories, you share hope to those who are going through a time of great anxiety and uncertainty.

In January, my wife noticed new bruising and dismissed it. After hurting her leg at a water park, my wife (38) was forced to go to the doctor, needing an MRI. During the visit, the unusual bruising was disclosed. A blood test was ordered. Within a matter of minutes, we were called back to our physician's office - an experience that still haunts me. More blood tests were ordered as they screened for every other condition under the sun.

A couple of blood tests later (Platelets 18K, 21K, and 19K), and a after few sleepless nights, ITP was the diagnosis. My wife was started on 40 MG of Dexamethasone for four days (ending last night). We will be going back for blood tests each Thursday from now until the end of May.

I keep replaying the last few months over in my head wondering what could have caused it. We had a child in 2016, my wife went off and on Birth Control Pills for the subsequent year-and-a-half. Her work was uncommonly stressful, working late hours through the fall and winter of 2018. I think we may never know the cause.

We are new to this process, and my wife is not a worrier, but I am. I wonder - at this stage, what questions should we be asking our hematologist and/or our Physician? Any advice you would give somebody starting out on this journey? What knowledge or insight helps to get us through the anxiety of the situation?

Thank you in advance, you've already helped more than you could know.
Tommy

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Wife - Low Platelets 1 month 7 hours ago #66373

  • thomasjohnwood
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One more sub-series of questions: As platelet levels rise and fall, are there symptoms to watch out for?

For example, since the Dex. treatment, the color returned to my wife's face - which is good. However, she has had bouts of both fatigue and hyperactivity (while are likely caused by the Dex.). She has had headaches - especially the last day or so, but the bruises are clearing. It's hard not to read something into everything.

Finally, is it common that at this stage, you eventually learn it's not ITP, but something else? I guess our initial fear of a cancer of some type (which hit us when we first got the call to doctor's office following the very first blood test) still lingers in the back of my mind. The Hematologist and physician seem very confident in an ITP diagnosis and reassured us that the issue is platelet only.

Just trying to learn how to properly read the situation.
Thanks,
Tommy

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Wife - Low Platelets 1 month 3 hours ago #66375

  • Hal9000
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Hi Tommy. Yes, ITP has a big impact on one's life. It takes awhile not to be emotionally overcome by it. Just have to give it some time. Figure out, shall I say, the ITP game.

thomasjohnwood wrote: ... My wife was started on 40 MG of Dexamethasone for four days (ending last night)...

It's been awhile but I think the 4th and 5th nights were the worse for me. Can't sleep mainly. It should get progressively easier after that.

...I keep replaying the last few months over in my head wondering what could have caused it. We had a child in 2016, my wife went off and on Birth Control Pills for the subsequent year-and-a-half. Her work was uncommonly stressful, working late hours through the fall and winter of 2018. I think we may never know the cause.

Stress? Based on that report alone (very limited info), Epstein Barr virus aka mononucleosis is a possibility. If so, counts would be expected to respond to the Dex treatments.

...We are new to this process, and my wife is not a worrier, but I am. I wonder - at this stage, what questions should we be asking our hematologist and/or our Physician? Any advice you would give somebody starting out on this journey? What knowledge or insight helps to get us through the anxiety of the situation?...

A few folks have problems finding a doctor they can work with. I got lucky, so it's hard for me to recommend anything specific.

When platelets are low symptoms are pretty unique to each person. Have to figure it out along the way.

Most folks that arrive here have already received a diagnosis of ITP and it is an accurate diagnosis.

Good luck with Dex.
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Wife - Low Platelets 4 weeks 3 hours ago #66392

  • Carcamoc10
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Hi Thomasjohnwood! I’ve been meaning to post a response here, but I’ve had a pretty crazy week!

Firstly, I’m sorry you guys are dealing with this diagnosis! The beginning was a horrible time in my life, and I’ve only recently been diagnosed (Dec 2018). I don’t have a lot of answers but being a part of this forum has helped tremendously and I thank the few people who have taken time out of their day to send me their thoughts and experiences! What I wish I knew when first being diagnosed is that there will be ups and downs...lots of them. It was easy to get caught up in feeling elated when my levels were rising, only to get devastated when I would bottom out and get sent to the hospital. I know everyone is different, but if you prepare yourself for the fluctuations and listen to your body, it should make it a much smoother ride! Your wife’s symptoms are probably something very specific to her, as we all present different things at different levels. For example, I’ve been at 1K platelets with only a few petechiae on my hands and legs along with fatigue while someone else at that level would be having nosebleeds, etc....she will have to listen to her body. I have noticed the more symptoms I get, the more likely it is that I am low again! As far as questions to ask your hematologist, the PDSA home page has a pretty good list of questions for your doctor! You can try to ask if they have a suspicion as to why your wife got the ITP, but from what I gather, it is hard to pin down a specific event! I do think if they ran the gamut of tests that they usually do when they found the low platelets, the ITP diagnosis is pretty accurate. Anyways, I hope this helps even a little bit, good luck to you and your wife! :)
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Wife - Low Platelets 3 weeks 6 days ago #66399

  • thomasjohnwood
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Quick update:

We began High Dose Dexamethasone (4 days, 40 MG) on Friday of Last Week. On Thursday (day 6 since beginning of treatment), we had our first follow-up blood count. Today, we learned Jill's platelet levels are at 165k. We were informed that getting up over 90k within the first week of treatment is a good sign (indicating her version of ITP is likely steroid responsive - which increases likelihood of remission).

While part of me knows that this is a positive sign, we know that by no means are we out of the woods. Bruising is clearing up and energy level has returned. Some of our anxiety about other conditions are beginning to fade - as response to the steroid is a strong indicator that it is an autoimmune response causing the low platelets.

We have blood tests scheduled each week over the next month. I'll continue to post the results - so that those who begin their ITP journey understand one of the many paths it can go down.

Thanks again to everyone who has posted or replied - it's nice knowing you're not alone.
Take care,
Tommy

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Wife - Low Platelets 3 weeks 3 hours ago #66462

  • thomasjohnwood
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So we went for blood work today, and she is down to 13k. She is so worried. She is on her menstrual cycle, but to drop from 165k to 13k in a week is pretty discouraging.

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Wife - Low Platelets 3 weeks 3 hours ago #66463

  • mrsb04
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Unfortunately counts can swing dramatically with ITP. Don't get disheartened.

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Wife - Low Platelets 3 weeks 2 hours ago #66465

  • MelA
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Sorry to hear that Tommy! Of course she is worried bless her heart [know you are too] but there is life with ITP. I was diagnosed in 1989 and a couple months later we moved to Tokyo. Before we left my MD getting advice from a hematologist wanted me off prednisone so they dropped the dose from 60mg to 30mg and my count hit the gutter so we moved with me on 60mg of prednisone.

I was interested to see how Jill's count did after the Dex as that was mentioned by my new hematologist if my count should go down drastically again. Is her hematologist going to ride this out for a bit to see if her count comes back up?

Hang in there!
"Instead of wasting your time worrying about symptoms, just get it checked out" -Nieca Goldberg, MD
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Wife - Low Platelets 3 weeks 46 minutes ago #66466

  • thomasjohnwood
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Our hematologist is going to wait a week and re-test before deciding to advance treatment. Considering Rituximab - but wants to see if the dip was invoked by her period (which appears to possibly be a pattern), and/or to see if platelets return to approx 20k - which appears to be her baseline.

Is such quick drops in platelets common with ITP? Are these inherently dangerous or a sign of something bigger and scarier than ITP? That's our biggest fear - as we are new to ITP in general.

Thanks again - just knowing there are others in our situation helps alot!

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Wife - Low Platelets 2 weeks 6 days ago #66468

  • Hal9000
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thomasjohnwood wrote: ...
Is such quick drops in platelets common with ITP?

Yes. At least for about two thirds of us. Sounds like she was able to get through the first pulse ok. What would really be encouraging would be a gradual increase in count response for each subsequent Dex pulse.

Are these inherently dangerous or a sign of something bigger and scarier than ITP? That's our biggest fear - as we are new to ITP in general...

There is no direct correlation between ITP and any other disease that I know of. One weak statement one could make is that having ITP may be an indicator, eventually, of having some other auto immune disease. But in no sense is that a given. Having said that, there does seem to be a small fraction of steroid responders on this forum that end up with Lupus. As a counter balance. Be sure to educate one's self on the possibilities of CRISPR solving many diseases, potentially ITP and Lupus, in the not too distant future.
"CRISPR: The gene-editing tool revolutionizing biomedical research"
www.cbs.com/shows/60_minutes/video/dIdyXroziO4KUSRu_98VLALNMxtt7cXg/crispr-the-gene-editing-tool-revolutionizing-biomedical-research/

Cheers to stealing all the genetic solutions bacteria has found (eg CRISPR) to defend itself against invading viruses.
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Wife - Low Platelets 2 weeks 4 hours ago #66497

  • thomasjohnwood
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We went for my wife's weekly platelet count. So far, they have been as follows:

Week 0 - Diagnosis: 18K
Week 1 - Pre-Treatment: 19K
Week 2 - Treatment (4 doses of Dexamethasone): 165K
Week 3 - No Treatment (Menses): 13K
Week 4 - No Treatment: 30K

The results since treatment have been somewhat encouraging in spite of the low platelet levels. Energy levels are way up, immune system seems more resilient. Bruising is significantly reduced. Hematologist has postponed further treatment temporarily to allow for more monitoring.

We have a Hematologist appointment on Monday, May 13th - I'll share more following.

Thanks,
Tommy

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Wife - Low Platelets 1 week 6 days ago #66500

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Right on the borderline of treatment with that 30. Fingers crossed.

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Wife - Low Platelets 1 week 3 days ago #66520

  • thomasjohnwood
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Meeting with the Hematologist went well.

Because there is no visible bruising and no bleeding events, we are going to do two more rounds of Dexamethasone spaced one month apart each and will continue to monitor with weekly blood tests.

If that treatment doesn't inspire remission, then Rituximab will be the next course of treatment - which would begin in July and run through the summer.

My wife and I suspect a bit of a pattern. Her bruising seems to follow with her menstrual cycle. Her platelet counts tends to be lowest (and bruising highest) just a few days before her period - with bruising clearing and counts peaking about 10-12 days following.

However, because of a lack of corroborating evidence, the Hematologist is skeptical of CTP at this point in time. The hematologist also mentioned that with CTP, platelet count rebounds tend to exceed the "normal" limits of platelet levels, while my wife's appeared to peak at about 155k. Also, the only blood test confirmed rebound to date followed round 1 of dexamethasone - and is likely attributable to that, not fluxuations in hormones.

I wonder if the longer term monitoring will show a pattern - it is probably all in our head.

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Wife - Low Platelets 1 week 3 days ago #66523

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LOL, I think I've talked myself into improving counts, where none materialized, more than a few times.

Sounds like a game plan. I've only done one Dex pulse but I can see how several of them in a row could get old real fast. After the second pulse, she'll probably know the side effects like the front and back of her hand and dread the third pulse with a passion.

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Wife - Low Platelets 6 days 4 hours ago #66537

  • thomasjohnwood
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Week 0 - Diagnosis: 18K
Week 1 - Pre-Treatment: 19K
Week 2 - Treatment (4 doses of Dexamethasone): 165K
Week 3 - No Treatment (Menses): 13K
Week 4 - No Treatment: 30K
Week 5 - No Treatment: 64K

We will be starting a second pulse of high-dose Dexamethasone today (four days). Jill's anxiety around the whole situation has mostly cleared-up - viewing ITP as more of an inconvenience than a death sentence. Energy is still up. We had noticed a pattern in the past of platelets crashing a week before menses - which will be a few days after finishing Dexamethasone this round - so it will be interesting to see what happens.

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Wife - Low Platelets 5 days 23 hours ago #66540

  • mrsb04
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Week 3 - No Treatment (Menses): 13K
Week 4 - No Treatment: 30K
Week 5 - No Treatment: 64K


Personally with a count of 64 I would go for:-
Week 6- No Treatment

Then wait & see what happens on week 7

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Wife - Low Platelets 5 days 4 hours ago #66547

  • Hal9000
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Nice count. After only one pulse too.
Yes, treatments that give positive results helps one's outlook a lot. That's how Nplate and Promacta are so important to many.

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