Platelet's creeping up

[wateron]

Latest CBC

Hematocrit 44.7

Platelet 703

Hgb 12.8

WBC 12.4

RBC 5.90

First time I have been in the 700 range for Platelet's. Entered 600 range February of this year. Should I be concerned about the platelet's? Am 76 just on phlebotomy and aspirin. No physical symptoms.

[Mazcd Partner MPNVoice]

hello Wateron, platelets do go up and down all the time, even having a cold or an infection can cause them to rise, but always best to discuss this with your haematologist. Best wishes, Maz

[hunter5582]

It is normal for platelets to cycle by as much as 100 in a single day in response to what is going on in your body. It is the trend over time that matters. My platelets cycled by 200 for nearly 30 years (500s-700s) when I was not on cytoreductive therapy.

Note that there is not a linear relationship of thrombosis risk with platelets in the 600s - 700s. Thrombosis risk is more complex than that. It is actually your age that is the greater risk factor. It is actually the risk of hemorrhage that does go up when platelet levels are higher. It is actually the erythrocytosis that is the greater risk for thrombosis with PV.

Most, but not all, docs would have recommended cytoreductive treatment for someone with PV age > 60. Phlebotomy can do a good job controlling the erythrocytosis but has its own side effects. The intent is to create chronic iron deficiency, depriving the body of the iron needed to produce RBCs. Unfortunately the phlebotomy-induced iron deficiency can have adverse effects that for me included fatigue, loss of concentration, alopecia, and reactive thrombocytosis (PLT+200). For me, the iron deficiency symptoms were worse than the PV symptoms.

The good news is that there are other options to treat PV. I have done much better on the interferons, Pegasys then switched to Besremi. Suggest you review your questions and treatment options with a MPN Specialist.

All the best.

[wateron in reply to hunter5582]

Always appreciate your replies Hunter I'm just wondering how to strike a balance between my RBC & Hgb. The range from my lab for RBC is 4.10-5.70 which at 5.90 puts me slightly higher and the Hgb range is 13.0-17.0 which at 12.8 puts me slightly lower. I don't have any iron deficiency symptoms so maybe my RBC & Hgb results are ok for me. Was thinking of eating more iron rich veggies but don't see the need with the high RBC. I have been offered Hydroxyurea since diagnosed 3 years ago but declined. Besremi is also available. I'm just stubborn not wanting to take the treatment since I have no physical symptoms but the high platelets do concern me. Going for a phlebotomy today!

[EPguy in reply to wateron]

Your opposite ranges of Hb and RBC seems unusual. Maybe the plebotomies are the reason?

My MPN specialist says Hb is the most important red cell value to watch. But HCT is for historic reasons the one that is measured, so we get confusing results sometimes

HCT is actually calculated from RBC X MCV. So your MCV is likely on the low side. You might discuss with your Dr reasons why the RBC and Hb are opposite ranges, and what implications are for that.

In recent practice, long term Phlb is becoming less favored vs the cytoreduction Hunter refers. If you have access to Besremi it's worth discussing with your Dr. This agent can possibly stop or reverse the disease condition. Both I and Hunter have seen reductions in our mutations on it. In other posts even HU is discussed as preferable over Phlb for long term effects. These are tradeoffs you should discuss with a specialist as Hunter says.

[wateron in reply to EPguy]

"HCT is actually calculated from RBC X MCV" I must be doing the calculation wrong. RBC 5.9 X MCV 76 = 448.4 not the 703 my platelets are.

[EPguy in reply to wateron]

Sorry for confusion. It's the calculation for hematocrit (HTC) Your calculation is very near same as your lab's HCT (with the decimal point moved) 448-44.7.

According to this info, MCV is normally over 90. My provider uses 80. So yours is low, as expected from your results. Could be worth discussing with Dr whether this is significant in your case.

medicalnewstoday.com/articl...

You're right that PLT is not calculated, it's measured directly.

[hunter5582 in reply to wateron]

Bear in mind that phlebotomies loser the erythrocytosis but can increase thrombocytosis. your body reads the phlebotomy as a significant bleeding event. Bleeding = need more platelets. In addition, low iron can also cause reactive thrombocytosis. It increased my PLT by 200.

I get the stubborn part. After my last negative experience with hydroxyurea, I held off for a while. I opted for phlebotomy-only until the iron deficiency symptoms became worse than the PV symptoms. Besremi was not available then so I opted for Pegasys. I later switched to Besremi. My only regret is that I waited al long as I did to start the IFNs. It is the most effective and easiest to tolerate treatment I have experienced.

We are all different. It is your goals and risk tolerance that should drive your decision.

Wishing you all the best.

[wateron in reply to hunter5582]

The nurse who did my phlebotomy today said "Oh, after this phlebotomy your platelets will go down" As you said should be the opposite.