Dropping platelets
 

I know I am being paranoid....

I am on day 77 post 10/10 unrelated BMT for aplastic anemia. My platelets had hit an all time high of 156 but currently have been dropping now at 92. Do I have anything to worry about? This isn't a sign of rejection is it?

I was CMV positive and on twice daily iv Ganciclovir, which did drop my white count and ANC as a side effect. Finally my CMV came back negative so they were going to start oral Valcyte to prevent the CMV from coming back but they held it to help my WBC/ANC rebound, which it has. But now my PLTs are dropping so this couldn't be from all this could it?!? It just doesn't seem to correlate with the timing. I have now restarted the Valcyte.

I guess I am just nervous as I feel I have had a pretty smooth sailing so far.

Hi, Laura.

It's very good that you're asking questions because you notice a change. I think it's smart, not paranoid.

You could be hitting the same rather mysterious and temporary platelet count drop that I did after my transplant. Here's what I said in a post in 2002:

I had an unrelated-donor bone marrow transplant for MDS in October 1998. My counts recovered steadily in the early days but there was a definite, scary dip around day 70. We learned at that time that many transplant patients experience such a dip between about day 60 and day 80. The doctors could never really explain why but the anecedotal evidence was very consistent. Once I got past that point, my counts stabilized but remained low for about a year.

I also mention it in the first paragraphs of one of my profile pages.

Regards,
Ruth

Hi Laura,

Now İ am at day 54 and two weeks ago my plt and wbc drop a little bit.My doctor said to me,it can be about meds.İ used for cmv Valtrex and for infections Tavanin.I cut them for doctor saying,one week later my plt and wbc raise again slowly.
Now i start again Valtrex for protect again to CMV,will be again a little bit dropping seen.

Hi again,

I am at hospital now and we check i am at day 61.All my blood counts dropped.Last week my plt was 123 now 91,my hmg is 6,5 and wbc is 1,5.I hope this is temporary for me.I read your story Ruth and this is similiar like you.Today i take my mummy's cell a little bit again,and two bag red blood.

Hi Ruth.

My blood group is 0 positive.my donors blood is A positive.After 61 day i stiil take 0 positive when i need blood.İs this normal.Do you know average of blood group changings.

I asked the same question of my nursing team last week since my cross match tests were still saying B+ even though my last BMB confirmed I had 100% donor cells in my marrow (my donor is O+). I was just told that it takes "a while" for your blood type to switch over to your donor's, which was a surprise to me! I'm on day 64 today and still my original type, for reference. Maybe a long time transplantee can chime in when theirs changed?

Hi,
My last donor cell checked 30 days ago and % 98 donor,but yesterday my all blood counts decreased.They will check the test if the blood is mine or donor.So I am nervous now.I will wait one week or more to learn.

Yes, it can take a "long time" for your blood type to change over after transplant. But, just as blood type is not a key criteria for selecting a donor, it not a key element of your recovery. Serkan, you can continue to receive transfusions of type O blood even as your type begins to change since O is the universal donor. Eventually you will be able to accept either O or A. Don't focus too much on blood type. The more important number is your percentage of donor cells.

Regards,
Ruth

Hi Ruth

My Doctor called me last night and he said to me,my donor cell is %99.I am very happy now.

Laura,

With your lower platelet count and the doctor weaning the immunosuppressant a bit on the early side, I wonder if he is seeing some red cell fragments (schistocytes, shredded red cells) on your smear. Cyclo and tacro can cause microangiopathy (injury to the endothelial lining of the microscopic blood vessels, esp. in the kidneys). This causes your body to send fibrin and platelets to these areas of injury. The platelet count drops and the fibrin threads criss-crossing the little blood vessels cause the red cells to tear in half as they travel through. This would also keep your red cell count down.

Ask him if he sees red cell fragments on the smear. Maybe it's more common than we think as Evan had this as does another post BMT boy we are both following right now.

Keep well,

Nicole

Hey Nicole,
I don't see the doctor until Thursday but since I work at Mayo (and it's allowed), I went on a computer and pulled up my chart and looked. I don't see that there is any of them seen. But I will keep a close eye out for it.
Laura