Low Platelets: Diagnosis to be confirmed

Posted by rockitman @rockitman, Oct 14, 2022

I have a platelet count of 17 as of Oct 10th 2022. I lose about 800-1000 platelets a day. 5000 - 7000 a week between CBC.
My Dr has me on Promacta 50mg a day(4 weeks), Prednisone 80mg a day, 40mg morning, 40mg night (6 weeks), No help at this point.
Started Rituxan last Tuesday morning Oct 10th 6 hr treatment.
Three more 6hr treatments one week apart every Tuesday morning.
Has anyone had good results with Rituxan?
My Dr has changed my Diagnosis 5 times in as many weeks.
My bone marrow biopsy/asperation lists two possibilities, aplastic Anemia and Megakaryocytic Hypoplasia. He is currently dianosing me with Megakaryocytic Hypoplasia??????
At this point I'm not sure what I have?
I did contact Mayo Clinic and have gotten an Appointment next Wednesday, thank you Mayo.
Does anyone know how long it takes for the Rituxan to work if will even work at all. My Dr said 54 days? I don't have 54 days of platelets left at the platelet loss I'm experiencing now. Getting down to the critical stage, No bleeding yet that I can tell internally but bruising very easily.

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@elenarey77

It turned out I had severe aplastic anemia. My platelet count was at 16. Other cell counts really low too. I was treated with. ATGAM, cyclosporine, and Promacta.
Good Luck and best wishes!

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Hi @elenarey77 Welcome to Mayo Connect! Thank you for sharing your experience with Aplastic Anemia. That’s a very serious disease where the bone marrow isn’t producing blood cells…not just red cells but white blood cells and platelets too, as you experienced. So it’s very positive and encouraging to hear that you’ve had success with the medications!
Will you be on these for life or has it reversed the disease completely?

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@rockitman

Nov 1st@ 8:30am. Jacksonville, FL.
Thanks for the insight and info, as always, a pleasure to hear from you.
I'll let you know how it all goes.
Stay well.

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Hi @rockitman. Thought about you this morning with your bone marrow biopsy. I know it takes several days for all the aspects of the biopsy to get analyzed. Hope it all went well. Did you try the pleasant slumber option? 🙂

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It turned out I had severe aplastic anemia. My platelet count was at 16. Other cell counts really low too. I was treated with. ATGAM, cyclosporine, and Promacta.
Good Luck and best wishes!

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@loribmt

Hi @rockitman. You have to be relieved to have a sound diagnosis and plan joining forward!!
Personally, I’m relieved to know you’re getting regular platelet checks and infusions! Your reserves were getting pretty low. Ok, still no knife juggling but at least now you can relax a little.
Yes on the 2nd biopsy from Mayo. The bmbx (bone marrow biopsy and examination) are incredibly detailed and the equipment used by Mayo is state of the art. Your doctor can ask for specific tests on the cells collected for his purpose. I’m not surprised that a new bmbx is in the offing. And as a veteran of 13 biopsies, my preference is the quick general anesthesia they offer. You’re out about 15 minutes and wake up happy to juice and snack. 😃
That’s for reporting back. When the next biopsy?

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Nov 1st@ 8:30am. Jacksonville, FL.
Thanks for the insight and info, as always, a pleasure to hear from you.
I'll let you know how it all goes.
Stay well.

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@rockitman

Good morning, Well I have been diagnosed by Mayo Drs this week and it turns out I have MDS-Low grade.
Not ITP or Megakaryocytic Hypoplasia as previously diagnosed by my Hematologist/Oncologist.
Therefore, I have been taken off Promacta, Prednisone and Rituxan. Mayo has taken over my case.
I go to Mayo Clinic in Jacksonville, Florida on Nov 1st for a bone marrow biopsy. Mayo reviewed my recent bone marrow biopsy but wants to do their own biopsy, which is fine with me.
My new Dr from Mayo ordered a Platelet transfusion for me last Thursday and I went up to 48K from 14K.
I get checked every Tuesday for platelet count and go from there.
Thats all I have for now, more to follow when I know more.

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Hi @rockitman. You have to be relieved to have a sound diagnosis and plan joining forward!!
Personally, I’m relieved to know you’re getting regular platelet checks and infusions! Your reserves were getting pretty low. Ok, still no knife juggling but at least now you can relax a little.
Yes on the 2nd biopsy from Mayo. The bmbx (bone marrow biopsy and examination) are incredibly detailed and the equipment used by Mayo is state of the art. Your doctor can ask for specific tests on the cells collected for his purpose. I’m not surprised that a new bmbx is in the offing. And as a veteran of 13 biopsies, my preference is the quick general anesthesia they offer. You’re out about 15 minutes and wake up happy to juice and snack. 😃
That’s for reporting back. When the next biopsy?

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Good morning, Well I have been diagnosed by Mayo Drs this week and it turns out I have MDS-Low grade.
Not ITP or Megakaryocytic Hypoplasia as previously diagnosed by my Hematologist/Oncologist.
Therefore, I have been taken off Promacta, Prednisone and Rituxan. Mayo has taken over my case.
I go to Mayo Clinic in Jacksonville, Florida on Nov 1st for a bone marrow biopsy. Mayo reviewed my recent bone marrow biopsy but wants to do their own biopsy, which is fine with me.
My new Dr from Mayo ordered a Platelet transfusion for me last Thursday and I went up to 48K from 14K.
I get checked every Tuesday for platelet count and go from there.
Thats all I have for now, more to follow when I know more.

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Hello, I have reoccurring TTP. I have had 4 bouts, the first was in 2009. I was treated with Rituximab (Rituxin) through IV and it is a series of 4 treatments. Prednisone will also affect your blood sugar levels, possibly making them higher so please monitor. I was also treated with plasmapheresis (frozen platelets) to increase my platelets. My body shuts off the Adams T13 enzyme that makes platelets. I am wondering platelets should be between 150,000-400,000. My lowest was 6,000 and below 11,000 there is concern for internal bleeding! So I am confused with you number 17!
I hope you find answers! Blessings always!

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@rockitman

Lori
It is so kind of you to get me all this information and tell me about others who have faced this frightening medical issue. I have sent in 29 pages of my current Medical records, Bone Marrow Aspiration, Latest weekly CBC's, Complete Ultrasound, MRI's, etc to Mayo just so they could review my diagnosis to see if they would accept me as a patient. Thats how I was accepted or at least got the call from them that I would be meeting with two Doctors Wednesday morning Video Appointment.
If they need more, I'll be there in two hours.
Question: Did the Rituxan work before your transplant or after? I am scheduled for the 4 treatments, I had one last Tuesday, I had no problems or side effects at all, in fact they finished in less than the prescribed time.
Does the Rituxan provide any signs of working between the treatments that can be seen in your platelet count with the CBC taken before each treatment? My Dr said 54 days after my 4 treatments are finished before he knows if the treatment worked.
My problem is my Dr still has me on Promacta and Prednisone and one of them is causing me to have strong heart palpitations and lower leg swelling. I told him but he doesn't seem concerned. Told me to keep taking all the meds as prescribed. He keeps saying maybe the Promacta will start working.
Hopefully all this will change Wednesday after talking with the Mayo Dr's. I'm losing confidence in my current Dr.
I'm Curious to see if my number has dropped from last week's 17.
You have a blessed day and I'll be thinking of you too during your checkup.
I'll let you know how my Mayo visit goes Wednesday.
Thank you so very much.

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Good morning, @rockitman. Just so you know, every time I see your name, I hear Elton John singing Rocketman…my ear-worm for the past 2 days. LOL
At 80 mg, that’s a really hefty dose of prednisone you’re taking so I would suspect this is the culprit for your palpitations and swelling. Powerful miracle drug but it comes with side effects.
You’ll most likely develop what’s called moon face, which is a pretty common side effect from prednisone. It can also cause fat to be redistributed into your back/neck/shoulder area and your thighs. Pretty, huh? It goes away once you are off the prednisone. Feeling flushed, maybe sleepless but if you’re going to paint the house, now’s the time. 😅
Kidding!! With your low platelet level, you need to be cautious and no knife juggling.

Another word of caution with the prednisone…when your doctor decides it’s time to wean you off the prednisone, it will be a very long, slow taper to be safe. Never stop taking it cold turkey.
Do mention all of your symptoms this week in your consultation with the Mayo doctor Wednesday. Helps to make notes ahead of time.

You asked about whether the Rituxan infusions worked before my transplant. This treatment for me was post transplant and basically an educated ‘shot in the dark’ with my transplant doctor and neurologist collaborating to ‘fix’ a reaction I was having. I won’t go into details, but it worked! There was a permanent reversal to the damage on my spinal cord caused by my “new” B-cells in my newly transplanted immune system attacking the myelin sheath on my spinal cord. It never returned and that was the goal. I don’t remember if this showed up on weekly blood work. And again, you and I have/had different blood condition so we can’t really compare blood work. I had acute myeloid leukemia which was very aggressive and provided a lot of excitement! 😂

It will be interesting to hear the opinion of the Mayo team. In the meantime, have your 2nd infusion and take heart that it’s ‘good medicine’. From my understanding Rituxan will start to work very quickly on peripheral blood. That’s the blood in the body outside of the bone marrow. It will take a little longer for the drug to actually make a difference in the marrow and that’s why it’s a 50 day estimate. But it doesn’t mean that the med isn’t working all the while it’s in you and just starts at day 50. It’s already working from day 1.

Talk to you later this week!

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@emcdanie2006

Hi Rockitman,

I have ITTp and on 2 nd RITUXAN treatment.

My doctor tries not to allow my Adamst13 to go below 40. Recently, AdamsT13 dropped
from 42 IU/ to
ADAMTS13 activity, IU/mL Plasma 0.34 IU/mL . This also decreases my platlet count when the Adamst13 gets activated or
triggers my body to go into high alert. The infusion drip is slow due to the immunotherapy, 3-4 hours per treatment works for me. The Adamst3 will not moved until after the 5th round of treatment.
Rituxan works for me, thus far, prayer, digesting iron rich foods, and trying not to get sick gas been a winning plan.

Hope you get a 2nd opinion, as iTTP is a rare blood disorder . Hope you find a good hematologist that has knowledge on rare blood disorders.

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Good morning. I was told I had ITP by my first Dr. But I changed Dr's when he told me there was nothing wrong with me since the CBC showed no "Markers" for Cancer.
My second Dr has given me 5 different Diagnosis in as many weeks. My current diagnosis is
Megakaryocytic Hypoplasia. Basically, my immune system killing my own blood cells.
I have had the one treatment with no side effects last Tuesday, next treatment this coming Tuesday, then two more to follow each Tuesday, total will be 4 treatments.
I don't know what Adamst13 is, I looked it up and still could not figure it out.
I hope all goes really well for you, I surely know how this can act negatively on your mind.
I stay busy as much of the time as I can to keep me occupied on other things.
How often can you take Rituxan? I thought it was a onetime deal.
I'm glad to hear it is working for so many people. I hope it works for me too. My platelets are getting lower each day.
It's in Mayos hands now hopefully they can help me.
Thank you for the information .

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