Managing Low Platelets and White Blood Cell Count: A Patient's Journey

Treatment for thrombocytopenia and leukopenia?

Hello, doctor.
I would like to ask you about my mother.
She previously had a low platelet count of around 20,000 and was treated at Changhua Christian Hospital.
The doctor prescribed steroids (Dexamethasone) and an over-the-counter gastric medication.
The steroids were prescribed to be taken three times a day, four tablets each time, along with the gastric medication, two tablets each time.
After about a month of continuous medication, her platelet count only increased to around 40,000, which was not very effective.
Later, during a follow-up visit, the doctor prescribed a different regimen: steroids twice a day, three tablets each time, along with Mycophenolate Mofetil twice a day, one tablet each time, and the gastric medication twice a day, two tablets each time.
After using this regimen for two weeks and returning for a follow-up, we found that her platelet count still did not improve, but her white blood cell count had dropped to 1,200, which is below the standard value.
The doctor then discontinued Mycophenolate Mofetil and advised against continuing the other medications.
However, my mother developed a fever, so we rushed her to the emergency room and she was hospitalized for observation for about two weeks, but her white blood cell count only increased to 1,400.
My mother was very upset, wondering why the treatment for her platelets resulted in a decrease in her white blood cells.
I would like to ask the doctor if my mother's white blood cell count will return to normal.
I am also very worried.
Currently, the tests show: blood culture - no bacteria, complete blood count - white blood cells 1,400, platelets 3,000, and a bone marrow biopsy that is normal with no issues.
There are no viral or bacterial infections.
She is still hospitalized, being monitored for her white blood cell recovery and continuing steroid treatment.
What should the doctor do? What should we do?

A-Kai, 50~59 year old female. Ask Date: 2012/03/30

Dr. Lin Sixie reply Rare Disease

Based on your description, your mother may have idiopathic thrombocytopenic purpura.
However, it is important to rule out the possibility of infection or tumors.
Bone marrow examination is normal, which excludes the possibility of aplastic anemia.
The low white blood cell count may be a side effect of mycophenolate mofetil (an immunosuppressant).
Long-term steroid treatment can increase the risk of infection.
If platelet levels cannot be improved, there are several new thrombopoietin receptor agonists that can be considered.

Reply Date: 2012/03/30

More Info

Managing low platelet and white blood cell counts can be a challenging journey for both patients and their families. Your mother's situation, characterized by low platelet counts (thrombocytopenia) and low white blood cell counts (leukopenia), requires careful monitoring and management, especially given her recent treatments and hospitalizations.

From your description, it seems your mother has been diagnosed with a condition that has led to her low platelet counts, and the treatment regimen has included steroids and immunosuppressants. While steroids can be effective in increasing platelet counts, they can also have side effects, including the potential for lowering white blood cell counts, particularly when combined with other medications like immunosuppressants (e.g., mycophenolate mofetil, referred to as "移護寧" in your context).
The fact that her white blood cell count dropped to 1200 is concerning, as this level is significantly below the normal range (typically 4,000 to 11,000 cells per microliter of blood). A low white blood cell count increases the risk of infections, which is why your mother experienced a fever and required hospitalization. The medical team will likely continue to monitor her closely, especially since her blood cultures have returned negative for bacteria, indicating that there is no active infection at this time.

In terms of whether her white blood cell count will return to normal, it largely depends on the underlying cause of her low counts. If the leukopenia is a side effect of the medications, stopping or adjusting the dosage of those medications may allow her white blood cell count to recover. It’s also important to consider that if her bone marrow is functioning normally (as indicated by the bone marrow biopsy results), there is a good chance that her counts can improve once the causative factors are addressed.

The management of low platelet counts can be complex. If her platelet count remains low despite treatment, there are newer therapies available, such as thrombopoietin receptor agonists, which stimulate the bone marrow to produce more platelets. These options should be discussed with her hematologist, who can provide guidance based on her specific situation.

It's understandable that you and your mother are feeling anxious about her health. Emotional support is crucial during this time. Encourage her to express her feelings and concerns, and consider seeking support from healthcare professionals, such as social workers or counselors, who can help her cope with the emotional aspects of her illness.

In summary, while your mother's situation is serious, there are potential pathways for recovery. Continued communication with her healthcare team is essential to ensure that her treatment plan is adjusted as needed and that she receives the best possible care. Regular follow-ups and blood tests will help monitor her progress, and any changes in her treatment plan should be made in consultation with her doctors. Your support and understanding during this challenging time will be invaluable to her recovery process.

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