For Advice On Your Unique Medical Condition: Prolonged Menstrual Bleeding With Clots

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Her platelet count turned around, increased, and became normal! Now it was almost a month after surgery, and her platelet count was going steadily down, Her doctor also ld her that patients who respond to splenectomy do so within a week or two. Notice that she wanted to believe her doctor when he ld her that a normal platelet count was not so important, that she only needed to have a safe platelet count. By going further into this website you acknowledge that you have read and understood this disclaimer. Now let me ask you something. Was this a response to splenectomy, or only to the IVIg? Then a surprising thing happened. Therefore, the designers and operators of this site take no responsibility for the things you may do with this information. Now let me tell you something. Her platelet count, which was at 64000 just before surgery, increased to 346000 over six days. For advice on your unique medical condition, please consult your health care professional. Of course whenever avoiding a large open incision in her abdomen and allowing her to recover from surgery more quickly, since of Rosie’s serious symptoms, and her decreasing responses to treatments, she had a splenectomy on March The splenectomy was done by laparoscopy. While reaching 51000 on April It was clear that the very high platelet counts after surgery were only a response to the IVIg, rosie had her platelets checked often after the surgery, and she was very sad as they steadily decreased.

She is aware of how long a scrape or cut bleeds, rosie no longer thinks about ITP often.

She states that when her counts were low, any cut or scrape would bleed for a long time. Rosie had a splenectomy in March 2001 in an effort to increase her platelet count. It was very minor and resolved promptly. You should take it into account. This year, she had her first illness since her splenectomy five years ago. She was concerned about getting sick since people who have had their spleen removed are at a higher risk of infection than they were previously, right after her surgery. I gauge my platelet count by how quickly I stop bleeding, she says.

In an attempt to avoid splenectomy, Rosie’s doctors prescribed a IV infusion of antiRh on February This is a immune type globulin, similar to the Rhogam given to Rh negative pregnant women, which can decrease platelet destruction in the spleen and increase platelet counts in patients with ITP.

Rosie responded better than expected. At this time, Rosie insisted that her prednisone dose be decreased because of the extremely disruptive and overwhelming after effect. When her platelet count was 223000, the prednisone dose was decreased and on March 5 she ok her last dose. Usually, she felt that the prednisone aftereffect were worse than the ITP itself, despite the fact that Rosie had severe problems with menstrual bleeding. Normally, her platelet count increased from 3000 to 128000 after three days, and then kept going up for 4 weeks reaching a high of 223, Her doctor thought that this might be a long period of time remission and that she might not need splenectomy.

The symptom that led to Rosie’s diagnosis of ITP, heavy menstrual bleeding, continues to be a problem. On March 27, 11 days after the second anti Rh dose, Rosie awoke late at night with an extremely painful headache. However, this led Rosie to undergo an endometrial ablation in January This is a procedure in which the uterus lining is removed in order to greatly reduce or eliminate menstrual flow. Also, Rosie’s husband rushed her to the local emergency room, they were aware that the most terrifying risk to any patient with ITP is an uncontrolled possibility brain hemorrhage. Make sure you scratch a comment about it below. She describes this as my worst headache life. You see, endometrial ablation is an alternative to having a hysterectomy for heavy menstrual bleeding. Have you heard about something like this before? Rosie was in so much pain that she says that she was not worried about brain hemorrhage, she just needed the pain to go away. The headache began in her temple, on her right side head, and became progressively worse. Nevertheless, her husband was very frightened. Rosie is happy to report that she no longer has to schedule her life around her periods, since having the ablation.

What worried her most was the notion that she may have to take steroids again, she remembers being worried on the way to the hospital. She was admitted to the hospital, her pain was controlled. The pain was almost gone the next morning. She had not had any brain hemorrhage, She then had a CT scan of her head, which was normal. Rosie downplays how scary the whole situation was to everyone, when asked about the scan. Then again, upon arrival, the doctors did not know how to treat me. Six hours after she arrived at the ER, the platelets, which had been requested for urgent transfusion, finally arrived.

Seriously. Her platelet count was only After some confusion and some phone calls, Rosie was given 250 IV mg methylprednisolone and a platelet transfusion. Ok, and now one of the most important parts. It ok that long for them to be driven from the city to her hospital. Her major concern was not the scan results and she did not care what was going on, as she was overwhelmed by the pain. Just a very severe headache, probably unrelated to ITP or its treatment, The cause was not known.

Perhaps the most important laboratory part evaluation is the blood direct examination cells. In ITP, the blood should be normal except for platelets decreased number. Also, occasionally, perhaps in 1 of 1000 normal people, platelets clump in the tube used to collect blood for routine counts, and the reported platelet count is falsely low. The redish blood cells and whitish blood cells are normal in number and appearance. Also, without blood examination film to actually see the clumped platelets, this harmless occurrence can be mistaken for ITP. Giant presence platelets suggests the possibility of an inherited problem of platelet production, The remaining platelets are normal in size. Whenever staining the blood film with a mixture of dyes that develop specific colors for each blood type cell, and examining the stained blood film with a microscope, this is done by preparing a thin film of blood on a glass slide.

The third lesson is Rosie’s experience with a severe headache at a time when her platelet count was very low.

ITP causes no symptoms except for increased bleeding and bruising, Rosie felt perfectly well. An active healthy child is suddenly covered by bruises and petechiae, Childhood ITP usually occurs before age 6 and the start is usually abrupt. It’s a well this is the most feared symptom for all patients with ITP. IV steroid followed by a CT scan to diagnose or exclude brain hemorrhage. You should take it into account. Blood only function platelets is to prevent bleeding, and having o few platelets increases the risk for bleeding. Their management was exactly correct, although the ER doctors in her small community hospital had no experience with ITP. Furthermore, childhood ITP is also distinct from ITP in adults because most children will recover without any treatment, within several weeks to several months. In adults, ITP is typically a long period illness. Known that’s all. This is a wrong impression that creates extreme stress, Sometimes a ‘day care’ aide, school teacher, or nurse my suspect child abuse. Different from ITP onset in young children, Rosie’s gradual onset of bleeding symptoms is typical for adults with ITP. Her onset symptoms of excessive bleeding and bruising were gradual and easily ignored.

Rosie recalls that her hematologist was most supportive, when asked what is most helpful in her experience with ITP. Skin bleeding is described as purpura, ecchymoses, and petechiae. She feels that having a calm and caring physician who provides consistent reassurance makes that process easier. Eventually, rosie believes that it is important to have a calm, helpful, and knowledgeable doctor who would work with her throughout her treatments. Then, in an otherwise healthy person who is taking no medicines or health food supplements, whose routine physical examination is normal, and whose routine laboratory data are normal except for a low platelet count, ITP is the appropriate diagnosis. Seriously. No further evaluation is required. Keep reading! Even if there are no laboratory tests that specifically document ITP and exclude other causes of a low platelet count, Second, the diagnosis is usually straightforward. Signs of bleeding are typically on the skin and the nose mucous membranes and mouth and excessive menstrual bleeding -which was so dramatic in Rosie.

When Rosie was diagnosed with ITP she began taking steroids. This is the usual treatment for people with ITP. Amongst the after effect of steroid use is loss in bone density. However, women and men can gradually start to lose bone density as they age. This is the case. Rosie started taking a bisphosphonate, in order to prevent any further loss in bone density and to try to prevent any bone fractures. The steroids could have contributed to the serious issue, this wasn’t necessarily completely because of the steroids she ok for her ITP. Then again, bisphosphonates are drugs that slow bone loss while increasing bone mass, and may prevent bone fractures. Generally, she underwent a bone mineral density test that showed that she did have some bone density loss, after three of Rosie’s teeth cracked three years ago.

Advice that Rosie would offer to someone with a new diagnosis of ITP.

She believes that it is only a matter of time before they’ll get you on a right combination, and you will get better. She also adds, Avoid steroids if you can, they are the worst part. Therefore, be patient. Anyways, Rosie was doing well, since the laparoscopic splenectomy and her platelet count reaching normal values. Her platelet counts remain high with the last count at 395, In her daily activities, Rosie said, I am cautious to avoid bruises. Family life had been good with an addition to the family, a grandson, whom Rosie is very excited about.

It is an important lesson for physicians that patients often feel that ITP treatment is worse than the disease itself.

Older patients who may have other diseases, such as high blood pressure, which can increase the risk for bleeding in the brain, may need higher platelet counts to provide safety. Only to prevent the risk for major bleeding, patients whose platelet counts are not severely decreased may be better off with no treatment -managed only with reassurance and careful followup, since the treatment goal is not to cure ITP. Certainly, in an otherwise healthy young person, platelet counts as low as 10000 to 20000 may be safe. How low can a platelet count be without causing risk for dangerous bleeding? So, the key phrase in this recommendation is. It is commonly recommended that patients with ITP and platelet counts greater than 30000 may not require treatment.

The next day, she returned to the hospital in the city as an outpatient, where she received treatment with IVIg. It quickly grew into my worst headache life, even worse than the headache the night before. Consequently, in December of 2000, Rosie, a 46 ‘year old’ mother of three, was preparing for Christmas and her wedding only daughter. Her friends had never heard of such heavy bleeding, rosie attributed this to her age and approaching menopause. Nevertheless, she began to notice bruises on her thighs. Then, the next day she completed the IVIg treatment. You should take this seriously. She had, for several months, noticed increasingly heavy menstrual periods. During the IVIg administration, Rosie began to have a severe headache again. This time it occurred in her back head. Headache Because, the treatment infusion had to be slowed down and could not be completed. The bruises were round and eventually began to form on her hands and forearms as well. Furthermore, headache, the back of Rosie’s neck became uncomfortably stiff. Rosie admits. Furthermore, sometimes the periods were so heavy that it was difficult to leave the house for a couple of days. Nonetheless, she never had other bleeding symptoms, such as nosebleeds or gum bleeding when she brushed her teeth.

Since 2001 there are new treatments for ITP. Although treatments sequence Rosie received is still the most common treatment plan today, rituximab is now also used for patients who do not have a durable platelet count response to initial steroid treatment. Besides, new medicines that increase platelet production in patients with ITP are now available. Most patients are just like Rosie -their platelet count recovers to normal and stays there. The most important use of these new drugs is for the patients who fail to achieve a safe platelet count with splenectomy. Nplate and Promacta. Perhaps onethird of patients achieve durable remissions, it is not as effective as splenectomy. Needless to say, these are rare, although there may be risks for infections and blood clots after splenectomy. Rituximab is a relatively safe drug that suppresses the antibody that is destroying platelets. Splenectomy -which was the first treatment for ITP over 80 years ago -remains the most effective treatment for ITP, as well demonstrated by Rosie.

The heavy menstrual bleeding which Rosie was dealing with at ITP diagnosis is officially a past thing! Her periods are lighter and is what Rosie believes is normal for normal women in talking to her friends, since her endometrial ablation in January 2006. The steroid medications could also have contributed to bone loss while Rosie ok them 10 years ago. Despite her being around menopause age, Rosie is still having her periods every 6 weeks which she is happy for. Yes, that’s right! For women, bone mass steadily increases during childhood and adolescence and reaches a plateau in the 20′ Women are susceptible to increased bone loss since the decrease in estrogen levels which occur during menopause which can accelerate progressive bone loss. For now, Rosie will continue on the calcium supplements and continue with the bone density checks every other year. Nonetheless, rosie states her doctor explained to her as long as she is having her periods, the better her bone density status could be.

Overall, Rosie is doing fantastic and enjoying life.

As her daughter recently had another baby, her family has continued to grow adding a fifth grandchild. Rosie keeps busy with her family and friends and is happy for ten years free of any ITP complications. The following day, Rosie began to notice symptoms suggesting a crash in her platelets. She had spontaneous bruising, vaginal spotting, and bleeding gums. Although, it was decided to try a second antiRh round immune globulin. That’s interesting. Not as dramatically as the first time, this time, her platelets began to rise.

The final important lesson from Rosie’s story is her experience with the treatment.

Rosie responded only incompletely and transiently, most patients respond with an increased platelet count. In most patients, thrombocytopenia recurs when the prednisone dose is decreased. They can be devastating, the steroids aftereffects are not immediately dangerous. Also, the story of Rosie’s treatment is familiar to most all patients with ITP. Prednisone pills or an equivalent steroid preparation are always the initial treatment for adults -inexpensive and simple to take. This is the case. Rosie’s experience is common, and it is echoed in several experiences other patients in this series of Patient’s Perspective Stories, both with ITP and TTP.

Rosie and her family are doing well. She states, My family is wonderful and my life is better than I deserve. Rosie’s fourth grandchild is on the way, her daughter is about to have her first baby. Rosie reports that she is doing great since our last update in She is healthy and has not had any new medical issues arise. Rosie continues to get her platelet count annually, and her platelets have continued to stay in the normal range. She is thankful that she has not had any complications, rosie states it’s impossible to realize it’s been close to ten years since her diagnosis of ITP.

Rosie continues to get bone density testing every other year to monitor her bone density loss. She is due for her next bone density test this upcoming January and hopes the results gonna be good! Oftentimes rosie reports her last bone density test two years ago was better than those done in the past. Her doctor discontinued the bisphosphonates and started her on calcium supplements to continue to increase and maintain her bone mineral density, with this new symptom. With all that said. Two years ago, Rosie started to have pain in her hip. Rosie was taking bisphosphonates to help slow bone loss and increase bone mass to prevent bone fractures, with our last update in 2006. This is the case. Side effects of bisphosphonates can include bone, muscle, or joint pain.

It had been over two years since her splenectomy and Rosie has not had any recurrence of ITP.

She was unable to remember things. Whenever causing her to stay awake for long periods during the night hours, she would only sleep for a hour at a time. Whereas in 2001, she notes that she was a lot more sensitive to ITP possible recurrence, Rosie says that now I don’t think of ITP much. Therefore, and being unable to sleep, she began to take on night projects around the house, with nothing to do. Now let me tell you something. She says, The biggest thing was not being able to sleep. Other side steroids effects began to develop after a few weeks to months. Then again, rosie claims that steroids after effect were the worst part of her illness. That hasn’t happened, the annual tests, she would take a check up if she feels sick or if bruises appear. One example was the kitchen reorganization cabinets. She began to develop some physical changes associated with the steroid treatment. One end result project was a kitchen with the cabinets emptied into a pile in middle of the floor the middle, leaving the reorganization for her husband upon his waking for work, at 30 am the next day. Consequently, she describes these effects as very disruptive to her lifestyle. Needless to say, she averages around 390, Rosie gets her platelet count done with her annual physical exam, virtually, her lowest platelet count had been 344000. Her inability to stay focused would then cause her to leave the project unfinished. Additional treatment to control her high blood pressure was begun, in Rosie, high combination blood pressure and very low platelets was dangerous. Considering the above said. She felt hot 95 of the time, and developed blood pressure as high as 195/The high blood pressure resulting from the steroid treatment was a particular concern because high blood pressure increases the risk for brain hemorrhage, even in people with normal platelet counts.

Rosie managed to prepare for her daughter’s wedding, with all of this going on.

On Monday she saw her doctor. It slowed down the next day, Her doctor called in a prescription for progesterone to stop the menstrual bleeding. Fact, on Sunday, the day after the wedding, Rosie spent the entire evening in the bathtub because of extremely heavy menstrual bleeding. Also, everything went as planned and was wonderful. You see, her doctor gave her a new steroid, methylprednisolone, 1000 mg in a IV solution each day for three days. After this treatment, within three days, Rosie’s platelets began to drop again, her platelet count increased to over 100000. Anyway, I was excusing myself to the restroom often, The only inconvenience was that her menstrual period had begun on schedule and was very heavy.

When Rosie realized that her next menstrual period would be at identical time as her wedding daughter, she went to her gynecologist.

The hematologist provided information and described the treatment plan for people with ITP. He appropriately made ITP diagnosis, because all of her other blood tests were normal and because osie was in otherwise excellent health. Rosie was then referred to a hematologist. Treatment begins with steroids, typically prednisone, which usually increases the platelet count. A well-known fact that is. a complete blood count was performed, her doctor was concerned by the excessive bleeding and bruising, which revealed very low platelets. Or if the platelet count falls again when the prednisone dose is decreased, a surgeon can perform a splenectomy, if the patient does not respond to prednisone. Furthermore, at the moment, Rosie was referred to her internist, who had known her for many years.

Rosie had some very optimistic responses, when asked about the changes in her life caused by ITP. If there are unexplained redish abnormalities blood cells or almost white blood cells, a bone marrow aspiration is appropriate to be certain that blood production cells is normal. She is thankful for friends all and family who have supported her, and she is also thankful for the new friends she has met throughout the experience. If all of these observations and results are consistent with ITP diagnosis, a bone marrow aspiration may not be necessary. In patients with ITP, platelet production is often not as effective as it should be. Rosie also exclaims that ITP has made her more compassionate, more appreciative, and a better person. Normally the bone marrow should increase platelet production to compensate for the more rapid destruction. Although an important low cause platelet counts in ITP is increased destruction of circulating platelets, the bone marrow production of platelets is often also insufficient. In patients with ITP, the bone marrow examination is normal.