Hep C Discussion Forum

Gracie wrote:

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Thanks! now I remember this thread and that I was elevated slightly before my treatment, so hopefully it's just an indication of chronic hep c and not Necessarily HCC. and I think, correct me if I'm wrong, that HCC would have showed on my ultrasound. I guess I'll just buckle down and wait patiently as I try to climb aboard the Harvoni train. Hope I get a ticket sooner rather than later....

 

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Oh no, Gracie, I would not even be thinking about HCC.  First of all, it would be highly unlikely for anyone who is not cirrhotic (and generally cirrhotic for a long time) to develop HCC and we don't even know if you have cirrhosis at this point.  Second, in cases where elevated AFP levels are indicating a tumor the levels are typically much higher ( >100 at a minimum and often consistently on the rise).  Third, an ultrasound would be likely to reveal a tumor although not a really small one.   There is nothing to indicate HCC here. 

Please do get a fibroscan at least.  If you want a biopsy after you see the fibroscan results then you will have that option too.  It really is important to know your level of fibrosis for purposes of getting the proper tx protocol and for continued monitoring post-tx if you do have cirrhosis.  My understanding is that it has been 12 years since your biopsy.  Things may have changed and your platelet level is at least suggestive that you have some significant liver damage.  Last but not least, I'm not sure how it will work for you in Canada, but you may need proof of liver damage before you can get treatment right now.  

Gracie wrote:

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The AFP is worry some though, what would be considered cirrhosis level high?

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Hey Gracie,

I wouldn't fret the AFP too much at this point.  It's not uncommon to have elevated levels with chronic HCV.  My level has dropped to about where you are currently, after being much higher for several years prior to treatment.  A good thread to read thru...

http://hepcfriends.activeboard.com/t57343406/alpha-fetoproteinafp-test/

Hi Again Gracie:

I remembered that Malcolm wrote a post about low platelets not too long ago that I am re-posting here for you:

Hi Mary et al,

Ah, platelets. Humour me while I ramble a bit.

By all means, eat the foods as detailed in Tig's references. They're essential for healthy living. However, don't expect an increase in platelets, unless you have a specific deficiency e.g. Vit. B12 or Folic Acid.

We know platelets are produced from megakaryocytes in the bone marrow. They're called 'cells' even though they are just bits of cytoplasm without a nucleus. Their production is regulated by a hormone called Thrombopoietin which is mostly produced by hepatocytes in the liver. The usual Lab. range is 150,000 to 400,000. Many conditions cause decreased platelets. We are mostly interested in liver damage and drugs. Obviously, liver damage causes decreased Thrombopoietin production. Decreased platelet levels in cirrhotics is common. Portal hypertension results in an enlarged, engorged spleen. Many believe that reserves of platelets are 'trapped' in dilated splenic sinusoids. Others believe in a condition called 'hypersplenism', where platelets are actively destroyed. Serotonin and an autoimmune response probably contribute. Even HCV patients with less severe damage may have decreased platelets.

Many drugs effect platelet levels. Common drugs such as aspirin and the NSAIDs decrease levels. Interferon is well known as a bone marrow suppressant, and some Hepatologists will not use Interferon if the before treatment levels are below 100,000 ( or 75,000 depending on the Hepatologist). Age is also a factor. As patients age, the number and 'quality' of the platelets decrease. Over the age of 60, platelet levels of between 100,000 and 150,000 are not considered significant. Older patients may have normal levels, but decreased 'stickiness' of the platelets. This is why older people often have bruises or ecchymoses on their arms.

What level of platelets is safe? I have a mate who is an Haematologist. He has an autoimmune condition, and his platelets run at 70,000-80,000. When my platelets dropped to 30,000 during my treatment, I asked what was a safe level. He thought 50,000 was OK, but be careful with sharp objects-HAHA. I've no idea what is generally accepted, but he should know.

How can platelet levels be increased? Obviously stop any drugs like aspirin or NSAIDs etc. Elthrombopag is a drug that stimulates platelet production. Platelet transfusions may give instant but temporary relief. These are usually reserved for patients on Interferon, where you really don't want to decrease the dose.

So, if you have HCV, don't be surprised if you have low platelets. Although it suggests you have significant liver damage, the virus itself may cause autoimmune problems that affect the bone marrow. Since SVR, my platelet count has increased to 220,000, so SVR is a good way to get your count up.

As far as I know, the new DAA's don't have a significant effect on platelets, but a low level may preclude treatment. Cheers.