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Dr. Andrew Rynne

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Suggest treatment for low platelet count

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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3289 Questions

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Posted on Fri, 3 Mar 2017 in Medicines and Side Effects
Question: Dear Doctor,
I am aware that a very low PLT (platelet count) may have various causes, but could I please have answers to the following question.
(1) I understand that a very low PLT can be caused by a viral infection but that the PLT can increase a few days later and perhaps even get back into the normal reference range. Is this correct?
(2) I understand that a bacterial infection can also cause a very low PLT but that this is a less common cause. If a bacterial infection is the cause then can the PLT also increase after a few days even if antibiotics are not used.
(3) If someone has a suspected but not proven infection (whether viral or bacterial) on the basis of a high WCC and high (and increasingly high) CRP, which is not treated, could the symptoms of the patient temporarily improve for a few days and then worsen? Would this be very unusual?
(4) I understand that in the case of suspected sepsis/severe sepsis it is typical for both blood cultures and a urine analysis to be done. Why is it important to include a urine analysis, and not merely take blood cultures when there is suspected sepsis? As an "add on" to this question, would the urine analysis typically consist of dipping a UTI test strip into a specimen of urine or would attempts be made to grow cultures from the urine?
I am sorry that there are so many questions.
doctor
Answered by Dr. Panagiotis Zografakis 1 hour later
Brief Answer:
low plt can be caused by infections... but it's not common

Detailed Answer:
Hello,

it is true that low platelets can be caused by infections (both viral and bacterial) but this is not very common. When the infection subsides, the platelets will increase again.

It would be very unusual for a patient to improve while CRP rises. I would rate CRP as a more important market than the white blood cells because WBC counts can be altered by many factors and they can also be low with sepsis.

A urine culture is important if urinary tract infection is suspected. Blood cultures are not always positive even if bacteria exist in the bloodstream. Finding the initial focus of infection is helpful for further management.

I hope it helps!
Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 30 minutes later
Thank you Dr. Zografakis for your prompt reply.

As I understand you, a urine culture is very important in the case of strongly suspected sepsis. However, is it the case that a urine analysis (one that does not attempt to grow a culture) is also important in the case of strongly suspected sepsis. If it is not then could you tell me why it is not? If is is could you tell me why it is?

You mentioned it would be very unusual for a patient with an infection to improve if the CRP continues to rise. However, is it unusual to a patient's physical symptoms (doesn't appear to be as unwell) to improve in the circumstances in which a patient has an infection and the WBC remains high and the CRP remains high or gets even higher?
doctor
Answered by Dr. Panagiotis Zografakis 13 minutes later
Brief Answer:
both urinalysis and urine culture are important

Detailed Answer:
You're welcome!

Both a urinalysis and a urine culture are important. The urinalysis may show signs of urinary tract infection (like white blood cells, nitrates, etc). The urine culture will detect the pathogen and with an antibiogram we'll know which antibiotics are the most appropriate for treatment. There are cases where bacteria are present in the urine without an infection, so both tests are helpful.

It would be strange for a patient who's getting worse (judging by the rising CRP) to be better in any way. There are some patients that don't look as ill as they are but it's unlikely to see signs of improvement when their CRP is rising. This is probably because CRP is produced when inflammatory molecules circulate in the bloodstream. These molecules are responsible for the feeling of malaise and many infection-related symptoms.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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