Low white blood counts and platelets

When I was on Gem/Cis, my hemoglobin dropped to 7.0. I could barely walk 20 feet without being breathless/short of breath and felt horrible. The ER consulted with my oncologist who did order a transfusion. But, they were still hesitant with the hemoglobin at 7. For whatever reasons…low blood supplies….I don’t know….but one hospital has decided to put the threshold at 7.0. I got the transfusion and two days later, felt much better.

With the MDS that started last fall, I have gotten a number of packed red blood cell transfusions…..and again, the one hospital my clinic was associated with, still had the threshold of 7. Even at 7, they sometimes balk. However, I changed oncologists…another clinic entirely in January, and they are more closely associated with our other hospital, which has the area blood bank. They leave it up to the doctor more to decide and my new onc said that he transfuses at 8 to try to keep the hemoglobin more at 9 or 10, which is more livable/quality of life.

To show just how much divided opinion there is on this subject, my Mayo hematologist said transfuse at 7, unless very symptomatic at a higher number, because everybody is different.

To further complicate this whole subject, if someone needs a lot of transfusions then there is a question as to ferritin level in the blood and body organs from getting too many transfusions . The ferritin/iron can damage organs if the number gets too high. So, for someone who may need to get a lot of transfusions, it becomes an issue of balanacing quality of life with possible iron overload problems when looking at the question as to when to transfuse red blood cells.

Iron chelation is possible to remove some of the excess iron from the body if the ferritin level gets too high from multiple red blood cell transfusions, but, I was warned by my Mayo doc that there can be significant side effects, so he’d rather I stayed away from that. He said that regular blood tests, withdraw blood, which also lowers the ferritin level, ….which is actually a treatment method for iron overload as well…..and obviously would have significantly less side effects. I’m not getting as many blood draws now as I was a couple months ago……because I’m in remission from the blood cancer. It takes many blood draws to bring down ferritin levels, so I’m not sure what next. There has apparently been found a correlation between high ferritin levels and less survival time for MDS patients.

They generally check ferritin levels after about 10 red blood cell transfusions. I read one place that said a ferritin level at 1000 was the threshold for starting chelation therapy. They checked my ferritin level after about 8 transfusions and it was at 1400. I haven’t seen the hematologist here at home since then to discuss it, but as I said, I did talk to the Mayo doctor who really wanted me to stay away from the chelation drugs.

As for platelets, the guideline I was told at Mayo was when they get to 15K, then they transfuse. The problem with platelets though, is that they don’t last long in the body…maybe about 4 days. The body “chews” them up pretty rapidly. So, if the count goes back down again after a transfusion of platelets, you may need more frequent platelet transfusions. My platelets were down as low as 11K and they did transfuse. I also got a transfusion before getting my port put in.

Julie

hopeseeker…from what I have seen on this site, the vast majority of patients recover from low platelets all on their own. However; doctors often prescribe Neupogen ( filgrastim )for neutropenia.

Hugs
Marion

Hopeseeker,
Does that mean her hemoglobin, and RBC are low also? If the hemoglocin is below 8, then yes she should get a transfusion. Keep immunity up with a lot of citrus or Vitamin C foods such as oranges, strawberries, or lemon water. Of course make sure she is not allergic. Check into supplementation also with Vitamin C, with the healthy diet. The vitamins are never a substitute for the healthy diet.

Hopeseaker….In addition to nycdaugher’s advice you may want to take a look at Livestrong’s recommendations: http://www.livestrong.com/article/17407-increase-white-blood-cells/

Also, remember that patients with low WBC (leukopenia) need to practice good hygiene, hand-washing, and food safety practices, as they are prone to infection.

Good luck and keep stay in touch. We are in this together.

Hugs
Marion