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What causes sudden drop of platelet count in blood?

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Posted on Fri, 22 Jul 2016
Question: Hello. My name is XXXXXXX About 2 years ago, during a routine doctor visit, labs showed my hemoglobin and platelets to be low (hbg around 10.5 and plt around 120). About 6 months later, my hemoglobin dropped to around 8.6 and platelets dropped to aound 80 and have stayed there for the last 15 months. I have had a bone marrow biopsy which showed a few abnormalities but low blasts. Later it was discovered that my spleen was enlarged to 20 cm with a lesion/mass of I think 9 cm. A PET scan showed hotspots in the spleen and a few lymph nodes in the neck (suv for spleen around 2.6, suv for lymph nodes around 4). Lymph nodes were removed and results showed benign and consistant with being reactive. I have been tested for rheumatoid and other auto immune disorders and all are negative. My doctor now is recommending removal of the spleen. My question is whether this is a good option or are there medicinal therapies that could be tried.
doctor
Answered by Dr. Deepak Sundriyal (1 hour later)
Brief Answer:
Hello dear. You require investigations

Detailed Answer:
Hello dear. Welcome to HCM. I have gone through the details. Before proceeding to splenectomy, I advise you to undergo some more tests as your case has not been properly investigated in my opinion. I would like to have following investigations:
Complete blood counts
S. LDH, Kidney and liver function tests
A repeat bone marrow aspirate and biopsy
An excision biopsy of the lymph node if enlarged.
The differential diagnosis will be a low grade lymphoma or some chronic infection. As of now i do not recommend a spleenectomy
Please revert back with the reports.
Thanks and regards
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Deepak Sundriyal (46 hours later)
Hello, thanks for your reply. Some follow-up. My Liver enzymes are normal, BUN and SCr are normal. My LDH is norml and has always been. Haptoglobin is normal while reticulocytes are high (3.31). IgA, IgG and IgM are normal.
Hep B and Hep C antibody are non reactive. ANA and RA qualitative are negative.
Thanks
doctor
Answered by Dr. Deepak Sundriyal (1 hour later)
Brief Answer:
Hello dear. I would like to see your PET SCAN

Detailed Answer:
Hello dear. I have gone through the details. I would like to see the peripheral smear of blood, direct coombs test, bilirubin indirect levels, and if possible a PET directed biopsy of any hot spot lesion.
It will be difficult to draw a final conclusion without these reports.
Removing a spleen is a major issue and removing it without arriving at a diagnosis can be hazardous.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Answered by
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Dr. Deepak Sundriyal

Oncologist

Practicing since :2005

Answered : 1546 Questions

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What causes sudden drop of platelet count in blood?

Brief Answer: Hello dear. You require investigations Detailed Answer: Hello dear. Welcome to HCM. I have gone through the details. Before proceeding to splenectomy, I advise you to undergo some more tests as your case has not been properly investigated in my opinion. I would like to have following investigations: Complete blood counts S. LDH, Kidney and liver function tests A repeat bone marrow aspirate and biopsy An excision biopsy of the lymph node if enlarged. The differential diagnosis will be a low grade lymphoma or some chronic infection. As of now i do not recommend a spleenectomy Please revert back with the reports. Thanks and regards