Nplate and sudden change in count

I sure was happy when my count finally went up to 100 while I was on Nplate. I had been hanging in between 30 and 60. Then one week my count was 100. To my dismay, the doc reduced my dosage the following week. My brave little platelets fell to 40, and then 3 days later they were back to 100, and doc lowered me again.
I am going to have a hip replacement in June, and I was really hoping I could do it without having to have IVIG.
I am confused as to why Doc is trying to keep me below 100. Nplate's web site does not indicate that this would be a problem.
Am I missing a reference?
Jean

From www.nplate.com , second paragraph on the first page:

"Nplate is used to try to keep your platelet count about 50,000 per microliter in order to lower the risk for bleeding.
Nplate is not used to make your platelet count normal."

Both Nplate and Promacta are designed to keep platelets in the 50k range. You risk clots otherwise,
Your doctor is following the manufacturer's protocol.

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Jack is correct. The dosage should be adjusted to keep counts around 50k. You're lucky that your doctor is doing it right. Many are not properly dosing and patients counts are too high. Maintaining in the 30k to 60k range is ideal.

You may have to do something else to get the counts up for surgery. Your doctor should be able to advise you about that. Most likely, 100k would be good for the surgery but that is up to the surgeon.

Higher risk for blood clots:

You may have a higher risk of getting a blood clot if your platelet count becomes high during treatment with Nplate®. You may have severe complications or die from some forms of blood clots, such as clots that spread to the lungs or that cause heart attacks or strokes. Your healthcare provider will check your blood platelet counts and change your dose or stop Nplate® if your platelet counts get high.

Recommended Dosage Regimen
Use the lowest dose of Nplate to achieve and maintain a platelet count
≥ 50 as necessary to reduce the risk for bleeding. Administer Nplate as a weekly subcutaneous injection with dose adjustments based upon the platelet count response.

www.nplate.com/patient/how-nplate-may-help/how-nplate-works.html

Trust your dr when I first started on nplate my dr at the time kept me over 100 and I ended up having a stroke at 25 years old. Blood clot risks go up dramatically, my dose was never changed and my platelets ended up getting over 700,000. You think it can't happen because of itp, I didn't either but it does.

Is there the same risk (of blood clots with higher counts) with Promacta as with Nplate?

Thank you for your help. I usually know my stuff. I think the dosage guidelines may have changed since I started treatment. I read the caution on the Am gen Web site, but I think it was a caution not to let platelets get too high
..and I could not understand how 100 could be too high. I do trust my doc. I am also confused as to why I am suddenly responding more to the drug.
Also, has anyone had major surgery while treating with nplate? I am curios about what protocol was used. My Doc may use ivig, and said something a while ago about stopping the n plate prior to administering the ivig.
Again,thanks for your responses. They got me into a better frame of mind.
Hi Sandi, you're aways there with solid info.
Jean

karenr wrote: Is there the same risk (of blood clots with higher counts) with Promacta as with Nplate?

Yes, definitely.

jef wrote: I am also confused as to why I am suddenly responding more to the drug.

That's the way it often seems to work. They didn't anticipate that that would happen but anecdotal evidence shows that it does. Some go into remission eventually. I used Nplate for three years and was able to stop and have not used anything for a year or so now. I had normal counts for a while although now below normal, last count 87, it's still holding up.