hem question

[kendall]

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i'm looking for some insight concerning a family members lab results.
routine workup: platelets=19K, everything else in normal range
two days later: platelets=45K, everything else in normal range
patient is 60 yr old female
no palpable liver or spleen enlargement/tenderness
no history of jaundice or rash
no history of prolonged fever, cough, etc...
but
history of fatigue, muscle soreness x4yrs. diagnosed by FP as fibromyalgia. of course patient bruises easily (first noticed ~2 yrs ago), but never has had severe bleeding. last underwent surgery (gall stones) in 1981; normal platelets at that time.
any ideas??? i would love any info/ thoughts you all might have.

same case, different question: would you ever let someone with a platelet count of 19K walk out of your office, not scheduled to see her again for 2 weeks? seems crazy (read dangerous), right?

thanks for any/all responses,

kendall
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outtacyte- a really great cell

 

[Surfer75]

Hrm, this pt has no past hx of any coagulopathies or ITP more importantly? Seems odd... if it was ITP, I suppose you could just treat her and follow her CBC... I've seen pts in O/P heme clinics with really low platelet counts sent home dx ITP and followed accordingly... clinically they were stable.. just pale.. and nothing much else.. so go with steroids/IVIG and wait&watch? Sorry, it's been a while since I did heme.. just what I can remember at this point.

JT

 

[DrQuinn]

Its not necessarily the # of platelets, but the quality of the platelets.

Some people can have 100,000 platelets but their BT is through the roof, and some can have 10,000 platelets and clot like a champ.

Q, DO

 

[kendall]

thanks for responding. it appears that the low platelet count may have come from excessive use of herbal supplements (ginkgo biloba, chromium, echinacea, etc...). i don't even know what all she was taking, but after 2 weeks off of them her count is up to 100K. lets hope this improvement continues. anyone ever heard of herbals affecting platelet count?

 

[ckent]

Don't know which specific herbals that can cause thrombocytopenia, but there are a lot of drugs that cause thrombocytopenia, so since herbals are drugs, I'm sure that there are a lot of herbals can cause thrombocytopenia too. You can look up a list of these drugs by yourself and figure out if your grandmother was taking any of these. Following up on asymptomatic platelets 15 K is fine I think, it's not a level that you would necessarily have to transfuse with platelets and if the etiology was unclear (ie if it was ITP), a platelet transfusion would have been wasted on her. And tell your grandmother to stay away from herbals, just because it's "natural", it doesn't mean that it's safe. If she doesn't believe you, remind her that cyanide is "natural" and will kill you all the same.

 

[citygirl]

THE ONLY HERBAL I HAVE HEARD OF CAUSING CLOTTING PROBLEMS IS WILLOW BARK (USUALLY IN THE FORM OF A TEA) BECAUSE IT CONTAINS SALICYLIC ACID. BUT I DON'T KNOW WHAT EFFECT THAT HAS ON PLATELETS. PATIENTS ON ANTICOAGULANT THERAPY HAVE TO AVOID CERTAIN FOODS AND SUPPLEMENTS THAT COUNTERACT THE DRUG ACTIVITY BUT THAT IS THE OPPOSITE PROBLEM. IT IS ALSO POSSIBLE THE LAB MADE A MISTAKE, ESPECIALLY IF EVERYTHING ELSE WAS NORMAL. DID THEY CHECK A PROTIME (INR), PTT AND/OR BLEEDING TIME?

 

[kendall]

i think that the problem was not so much herbals, as the combination of herbals and a prescribed medication. she takes beta blockers for her heart. i've read that bb's can cause thrombocytopenia by itself, but none of the docs ever suggested that the beta blockers might be the culprit of the low platelet count. but hey, what do i know... i just got out of undergrad.
thanks for the responses!!!
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"we had two women come into the ER last night. Joy was suffering from depression, and Chastity had VD." -medical bloopers 2003 edition

 

[Dr. SS]

like someone else said, if their platelets are 10k or above with an ok BT, we send um home for F/U in clinic.... its about the quality of platelets. now under 10k, with a Normal to moderately abnormal BT, we will probably investigate a bit more if otherwise asymptomatic..

late...

 

[kendall]

that's good to know dr.ss. but.... they never did a bleeding time. i thought bt's were considered a bit archaic anyway, what with all the coag series available now. but what do i know; i'm just a med school applicant.
btw, dr.ss are you from cali? i haven't heard anyone say "late...", since i left there 3 years ago. it's what you hear when someone clicks their cell phone closed as they're saying "later", so lots of people in LA just say "late".
...or maybe you were just saying "its late".
anyway, looks like quitting the herbals is doing the trick. her count is up to 120K. thanks for all the input guys/gals!!!
🙂