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AA Aplastic anemia

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  #1  
Old Wed Mar 13, 2013, 01:36 AM
mdb1986 mdb1986 is offline
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Hi All:

Sorry to bother all of you, but am hoping you can provide some guidance. I got autoimmune hepatitis about 6 years ago, at 20 years old. I am in stage 3 cirrhosis. Has been stable. I recently came off my medications (azathioprine). While on the medication, my blood counts were normal. Now off the medication, my blood counts are very low, which is odd. I have a lot of fatigue and am bleeding pretty easily. I have petechiae all over my body. My platelets are 108, WBC 2.3, RBC 3.6. My only thought is there is something wrong with my bone marrow - which sort of makes sense given that azathioprine completely screws with your bone marrow and has all sorts of warnings about it causing leukemia and other blood disorders.

How would I get diagnosed or find out what this is? Are my symptoms in line with AA? Any help is immensely appreciated. Thanks!
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  #2  
Old Wed Mar 13, 2013, 02:29 AM
Chirley Chirley is offline
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Hi, i Googled cirrhosis and CBC and i found the quotes below.

Reduced white blood cells or platelets: This may indicate portal hypertension, a complication of cirrhosis in which pressures are increased in the portal vein.


Platelet count: Number of platelets in your blood (may be altered in cirrhosis).

Perhaps coming off the medication has caused your liver to alter your blood results. I suggest you ask your hepatologist if the blood results are liver related.

Regards

Chirley
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Old Wed Mar 13, 2013, 02:37 AM
mdb1986 mdb1986 is offline
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Thanks so much. Liver counts were taken on the same test and came back normal. I see what you're saying, but I've had cirrhosis for years and never had blood counts even close to these.

It's odd, because the medication I WAS on is supposed to cause what's happening now that I'm off it.

My only thought is something immune related that the medication was suppressing is now occurring in my bone marrow.

I'd even say I just had a really bad infection, but that doesn't make sense with the low platelets.

Could be completely wrong. What tests are done to test bone marrow? Is taking a sample of your marrow pretty much the only one?

Thanks!
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Old Wed Mar 13, 2013, 06:43 AM
NLJabbari NLJabbari is offline
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You need a referral to be seen by a Hematologist. They will probably take a peripheral blood test and most likely a bone marrow aspiration to check what your marrow looks like. To my understanding, hepatitis can be the cause of Aplastic Anemia. From the counts you mention, I would guess you might be considered moderate AA. Of course this is only my guess... Please make an appointment with a Hematologist as these procedures can take a bit to schedule and get results.

BTW, I'm just wondering when were your last counts taken? It seems to me that if your platelets are at 108K, you really shouldn't be bleeding easily or be experiencing too much petechiae. You should check this out soon as maybe your counts are dropping...

Keep us posted and take care
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06/2004 my son was dx with SAA at the age of 10. No sibling BM match. He underwent ATG (H)/CsA. Relapsed 05/12 & dx'ed w/PNH. Currently in wait/see mode for Solaris as he is asymptomatic...
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Old Wed Mar 13, 2013, 03:27 PM
mdb1986 mdb1986 is offline
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Thanks. I've had the petechiae for years, slowly increasing. It seems to be a side-effect of the azathioprine. The bleeding isn't terrible, but I can tell it takes a lot longer for a cut to quit bleeding than it used to - and things are slow to heal.

I just got the results taken 2 days ago.
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Old Wed Mar 13, 2013, 04:06 PM
NLJabbari NLJabbari is offline
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Glad to hear the bleeding isn't random bleeding like from the gums or nose bleeds. But again, you really do have to go see a Hematologist so that you will know where you stand. Also, there might be newer and better meds for your hepatitis/cirrhosis. I've heard of others with hepatitis that are doing quite well bc of the drug combinations they were given.

I hope you find answers and don't ever feel like you're bothering anyone! It's your health and you have to keep looking for answers so that your liver might regenerate. Do you take milk thistle or any other supplements/herbs for your liver? I found a web page "The Liver Doctor" Sandra Cabot. There are pretty good articles re: liver health on that sight. www.liverdoctor.com You might want to take a look.

Take care
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06/2004 my son was dx with SAA at the age of 10. No sibling BM match. He underwent ATG (H)/CsA. Relapsed 05/12 & dx'ed w/PNH. Currently in wait/see mode for Solaris as he is asymptomatic...
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  #7  
Old Wed Mar 13, 2013, 06:20 PM
Marlene Marlene is offline
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You also need vitamin K in order for blood to clot properly. With your platelets at 108, I'm surprised you have that much petechiae.
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Marlene, wife to John DX w/SAA April 2002, Stable partial remission; Treated with High Dose Cytoxan, Johns Hopkins, June 2002. Final phlebotomy 11/2016. As of January 2017, FE is 233, HGB 11.7, WBC 5.1/ANC 4.0, Plts 146K.
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Old Wed Mar 13, 2013, 11:04 PM
Chirley Chirley is offline
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Liver failure in itself can cause a coagulopathy which can result in petechia. It is not necessarily due to low platelets but is caused by a decrease in other blood clotting proteins.

I'm surprised to hear that you have normal liver enzymes with cirrhosis. I'm really pleased that you have done so well with your treatment. It makes sense that if you have an autoimmune liver problem that you can develop other autoimmune problems as well.

I hope you get some answers soon.

Regards

Chirley
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  #9  
Old Thu Mar 14, 2013, 12:04 AM
mdb1986 mdb1986 is offline
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Thank-you so much everyone for your answers and support. I am working on getting some more tests run and hopefully figure out what's going on.
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  #10  
Old Thu Mar 14, 2013, 12:51 AM
BrianFlaigmore BrianFlaigmore is offline
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I had an acute attack of autoimmune hepatitis before (or when) I became aplastic. I know this doesn't mean it's the case for you, but I know that it is fairly well documented.
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26m Mystery liver failure 6/11 treated with prednisone. Falling counts, Rituxan attempted for Evans syndrome 11/11. Tx dependent and SAA dx 12/11. hATG 2/12, no response. MUD BMT 5/6/12. Living life!
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  #11  
Old Fri Mar 15, 2013, 09:49 PM
evansmom evansmom is offline
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I second Brian's comments, I've heard and read of at least a handful of AA cases that occured after autoimmune hepatitis. The Imuran you were on likely kept the autoimuune attack on your bone marrow (that no one could have been aware of) in check. Is restarting the Imuran an option?
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Nicole, mom to Evan (20); diagnosed SAA November 2007, hATG mid-November 2007, no response after 6 months, unrelated 9/10 BMT June 2008, no GVH, health completely restored thanks to our beloved donor Bryan from Tennessee.

www.caringbridge.org/visit/evanmacneil
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