Blood test Result

[Kiwi77]

My Platelet count on my three monthly blood test has gone from 201 to 160 do they increase again or keep going down.? WBC is now 57.8 and Lymphocytes 53.5 Heamoglobin 140 Neutrophils 3.6 Basophils 0.2.

Thanks

[cajunjeff]

Kiwi, as with almost all our labs when we have cll, they can fluctuate and bounce around a bit, so its possible your platelets could appear to have gotten better on your next test. That said, once most key cll indicators start trending in a certain direction, they will over time generally continue to trend in that direction.

Put another way, once our cll becomes active, most of us will see our platelets trend downward over time as well as our hemoglobin. This is usually as a result of our lymphocytes trending up and making less room for our healthy blood cells.

Now once a person starts treatment for cll, they will likely see their platelets recover. Mine were around 60 at their worst before treatment and now hover around 125. I am still a bit below normal, but 125 is my new norm and no problem. Many people will see their platelets go back to normal range after treatment. Every once in a while, mine will bounce back up to low normal, but I think thats just variations in testing.

Of course this is just a lay person opinion. Your doctor is the best person to comment on how your platelets are trending.

[Rohail in reply to cajunjeff]

At what levels of lymphocyte counts do we start seeing a tangible drop in platelets. My cll specialist said that at one point the clonal cells run out of energy to clone and the cloning starts to slow down or plateau. I wonder how many folks on the forum who have been in W&W for years have experienced this plateau

[AussieNeil Partner Administrator in reply to Rohail]

There isn't much, if any correlation that I know of between blood lymphocyte count and platelet count. That's because due to the heterogeneous nature of CLL, the CLL tumour distribution is also heterogeneous. In some, it can be mostly in the blood, others in the nodes and spleen and others in the bone marrow. It's the bone marrow infiltration that impacts the platelet count.

Neil

Varying lymphocyte natural 'growth' curves, including plateauing and reversal!

[Quarry in reply to AussieNeil]

Neil

What has that diagram come from - it looks very interesting! Can you provide a link to the paper? THanks

[AussieNeil Partner Administrator in reply to Quarry]

The plots are from Growth dynamics in naturally progressing chronic lymphocytic leukaemia

Nature. 2019 June ; 570(7762): 474–479. doi:10.1038/s41586-019-1252-x.

Michaela Gruber1,2,3, Ivana Bozic4, Ignaty Leshchiner2, Dimitri Livitz2, Kristen Stevenson5,

Laura Rassenti6, Daniel Rosebrock2, Amaro Taylor-Weiner2, Oriol Olive1, Reaha Goyetche1,

Stacey M. Fernandes1, Jing Sun1, Chip Stewart2, Alicia Wong2, Carrie Cibulskis2, Wandi

Zhang1, Johannes G. Reiter7, Jeffrey M. Gerold7, John G. Gribben8, Kanti R. Rai9, Michael

J. Keating10, Jennifer R. Brown1,11,12, Donna Neuberg5, Thomas J. Kipps6, Martin A.

Nowak7,13, Gad Getz2,12,14,15, and Catherine J. Wu1,2,11,12

1Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

2Broad Institute of MIT and Harvard, Cambridge, MA, USA

You might recognise some of the authors

Unfortunately, the full paper is paywalled.

Neil

[Spark_Plug in reply to AussieNeil]

"It's the bone marrow infiltration that impacts the platelet count". does this mean that I should get my marrow tested? I'm in the high 80's now? Is there a low end that tells us to check marrow?

[AussieNeil Partner Administrator in reply to Spark_Plug]

The iwCLL Guidelines has this to say regarding your question:-

"1.3.5. Marrow examination

In CLL, typically .30% of the nucleated cells in the aspirate are mature lymphoid cells. The extent and pattern of marrow infiltration (diffuse vs nondiffuse) may reflect the tumor burden.60 A marrow aspirate and biopsy generally are not required for the diagnosis of CLL; however, a marrow biopsy and aspirate can help clarify whether cytopenias (neutropenia, anemia, thrombocytopenia) are related or unrelated to leukemic infiltration of the marrow. In these cases, a marrow biopsy may provide important information, in particular before starting therapies with cytotoxic agents. It is recommended to repeat a marrow biopsy in patients with persisting cytopenia after treatment to clarify disease- vs therapy-related causes. A marrow biopsy is mandatory to confirm a complete remission (CR; see section 5.1)"

Neil

[Spark_Plug in reply to AussieNeil]

Thank you AussieNeil very much.

[LeoPa]

Mine keep fluctuating. If you check my posts you will see my labs.