Went to my Hematologist this week and she said I'd probably need treatment within a year because my platelets were down to 125. They have been sliding down from around 150 since October. The thing is my WBC is only around 6.0. Before my I/V treatment 5years ago my platelets never got this low and my WBC went all the way up to 200. It just doesn't make sense to me that the platelets should be this low when my WBC is still within normal limits although, my WBC has also been rising during this time but only from about 5.0
Anybody ever see this before.
john
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johnliston
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Yes, my platelets were dropping. Platelets below 100 (94) and enlarged and an uncomfortable spleen (18.8 cm) prompted my treatment. All of my other blood counts were normal except for my platelets and lymphocytes. My platelets were dropping slowly over the years, it took them more than 9 years to change from 145 to 94. They also plateaued for a couple of years around 120. Your platelets might stabilize too.
The internationally used iwCLL guidelines allow for a platelet count below 100, provided it is considered 'stable'. Mine dropped to the low 50s before treatment was recommended.
Importantly, your lymphocyte and platelet blood counts are measuring different aspects of how your CLL is impacting your health; your lymphocyte count is simply the measure of the CLL tumour load in your blood; CLL cells which cycle between your blood, nodes and bone marrow, while your platelet count is a measure of your bone marrow production. As CLL infiltrates your bone marrow, your platelet production will eventually drop. There's also the risk of ITP - Immune Thrombocytopenia, when immunoglobulins from mis-programmed B cells cause the destruction of platelets, but that usually comes on faster.
I quess my real question is if it's normal for platelets to be trending down and this low while my WBC and ANC are still in the normal range in CLL or is this something else?
Yes, with the SLL presentation, the ALC/WBC is normal. Your case is rather unusual though, given you had a high WBC prior to your previous treatment. You might also be developing ITP.
Neil, just thought i'd let you know, I neglected to mention in this post that I've been on Rituxan for the last year for AIHA. I didn't think it was relevent at the time. I have since discovered that Rituxan can suppress platelets and can be delayed onset. This kind of makes more sense in my case. I will talk to my Hem/Onc about it at my next appointment . I'll want it looked into before I consent to any treatment.
How many times did they check the platelets since October? Can this be a one off? Platelet measurements can be inaccurate. Something with breakage during handling blood samples. Trend is important. Maybe they stabilize here 🤞
My Hem/Onc is a fairly well known CLL Specialist and I trust her. I just didn't think to bring this up at my visit and I won"t see her again for another 2 months, so I thought I'd ask this group. If I'm still not satisfied after my net appointment I'll seek a second opinion. Thanks Jammin Me
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