ITP + low white blood cells?

Hi All,
I am wondering if anyone has experience with low platelets and low white blood cells (WBCs). My WBCs are typically less than 2 billion/L, which is half the normal minimum. In particular, my absolute neutrophil count is typically around 500/ cubic mm of blood, which leaves me vulnerable to infection. I have had bone marrow and blood tests for leukemia, lopus, and other autoimmune markers and they all came back negative. My platelet record low count was 1k/uL, at which point I stopped responding to steroids. Before that point, when I took prednisolone or dexamethosone, my WBCs and platelets could be managed. Now, I take eltrombopag (promacta), which allows the control of the platelets but does not increase the neutraphils.

I am interested to hear from others who have low neutraphils with low platelets, and hear of the ways it can be managed.

Thanks,
Bob

How much eltrombopag do you take ? At the start of 2016 I developed low neutrophils and low red cells as well as my existing low platelets and responded well to 75 mg daily .Over 2 years I have come down to 50x6 and 25x1 per week . Both red and white cells quickly normalised and my platelets though slower to improve at first are now staying between 100 and 150. I am diagnosed as having Itp not aplastic anaemia but Eltrombopag is now licensed in the UK for treatment of Aplastic Anaemia.

Hi Margaret.
Thanks for the reply and information. I take 75x3 and 62.5x4. This usually keeps my PLTs between 30k and 90k.
My haemaotologist also mentioned that there were reports of eltrombopag decreasing the other cells, and we did try to cut the dose, but my platelets fell below the 30 k threshold so we bumped the dose back up.
When I first discovered the platelet problem, the neutraphils were also low at that time. However, the average neutraphil count was probably higher than now. So it might still be possible that the eltrombopag is further lowering my WBC count.

When you were on 75 mg, how high did your platelets go? And how long did you keep the platelets at a high level before cutting the dose? Maybe the time that you stay at a high dose affects the chance of being able to cut it and retain a high platelet level.

Personally, I am very happy/impressed with Eltrombopag. It gives me a lot of control over the platelet count-- last year I had a small operation and we just upped the eltrobopag dose for a week to ensure the platelets were safe. It is just a shame that I have the WBC issue. I am now seriously considering having the spleen removed because it seems this can increase the WBCs as well as the PLTs.

Bob

I first went on eltrombopag 4.5 years ago. After a good initial response to 50 mg daily ,good enough to get me up to 200 for neurosurgery on my neck , my response reduced till after 3 years I was just at a count of 13. We tried Nplate and then rituxin plus Dex to no avail and as a last resort I went back on eltrombopag at 75 mg dailyin Jan 2016 after my platelet count fell to 1 and I was pancytopenic. However gradually things improved all round but it took about a year to get to a count of 100. After that my count kept rising and so I started very gradually reducing over the past year. The highest I have been is 160. If I am still above 150 in 2 weeks at my next appt I will come down by another 25 mg. but I am glad I have not tried to get down to 50 as some people suggest because next week I am due to have a Hysteroscopy and may need yet another op. So I will need my platelets! I am now 71 and at my age you just never know when you may have to go under the knife, so it's best to be a little prepared.