Nplate, higher counts, and clots

Yes, Sandi. I'm as confused as you. And I think the prednisone is just clouding the issue... Making it impossible to see what NPlate is really doing. My only motive for trying NPlate was to get off pred altogether. I wanted it gone by Thanksgiving, and here I am still stuck with it.
So then... You've helped me decide to put my foot down with Dr. Hema next week. I'll make him agree to reduce by at least 1 mg/day each week. That's not too fast, is it?

Thanks for your input, Robert. I'm so happy that you've achieved remission. That's what we all dream of, surely.

Robert1959 wrote: You mention that your NPlate dosage was being adjusted in 0.1mcg increments which I would have thought was almost immeasurable as 0.1mcg/kg = 0.0002ml/kg and that is why dosage adjustments are given in 1.0mcg increments.

Hmmm, no... maybe you heard that from someone else?
My initial dose was the standard 1 mcg/kg. After a very fast over-response (345k the 3rd week), the dose was reduced that week to .5 for two weeks. Then back up to 1, then 2, and now 3 mcg/kg since early Dec.

Interesting... I've never read anything in the prescribing information nor anywhere else about preferred injection sites. Since it's winter and because I wear long sleeves that are hard to roll up, most of my injections have been in the stomach just for convenience.
I'd be interested to see a reference that mentions stomach as the preferred site, if you can post one.

Sorry Janet it was my mistake in reading the earlier posts. The reference was in a post from poseymint (2 months and 3 days ago #45296) that talked about reducing a 3mcg/kg dose down to 2.9mcg/kg - my apologies.

When I started on NPlate, my weekly counts went 4, 7, 3, 4, 5 and then on L8 doses went 33, 315, 56, 228, 512 - after that I began the cycle that I had mentioned earlier.

Below are some extracts from the NPlate documentation that mentions the subcutaneous injection;

HIGHLIGHTS OF PRESCRIBING INFORMATION
[/u][/b]These highlights do not include all the information needed to use
NPLATE safely and effectively. See full prescribing information for NPLATE.
Nplate® (romiplostim), for subcutaneous injection
Initial U.S. Approval: 2008

2 DOSAGE AND ADMINISTRATION
2.1 Recommended Dosage Regimen
Use the lowest dose of Nplate to achieve and maintain a platelet count ≥ 50 x 109/L as necessary to reduce the risk for bleeding. Administer Nplate as a weekly subcutaneous injection with dose adjustments based upon the platelet count response.

Whilst I am only new to this forum, I read the various posts and I feel for everyone who battles this illness for such long periods - I don't know why I only had it for a short period and whilst it was grim for a while, for some reason my immune system just decided to go back to normal and it was only the NPlate that bought me time for this to occur otherwise I was probably going to have to have my spleen removed as a last resort.

Tomorrow is actually the first anniversary of my ITP diagnosis and hospital admission - it was certainly a year that I will never forget as I am sure you all can relate to.

Thanks for the reply.
As I understand it, "subcutaneous" just means "beneath the skin", as opposed to areas within a muscle or vein. Arm or stomach shouldn't matter.

Hoping your remission will be permanent!

Thank you for clarifying that. I thought that my nurses had said that it meant to the stomach region and I had assumed that that was the only site. I have since Googled it and can see that there are numerous sites around the body.
I think I need to check my facts first before making such bold statements!