Dr. Mubashir Razzaq Khan
Hematology
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Patient's Query
Hello doctor,
Three weeks ago, my mother was admitted to ER with critically low platelets and hemoglobin. Her hemoglobin has been above 7 g/dL for a week, but her platelet levels have not raised despite daily transfusions (even with HLA cross-matching). Two hours post-transfusion her platelet levels increase, however, they are decreasing by the next day. Bone marrow biopsy is not feasible for her condition.
She has metastatic BRCA-positive ovarian cancer and has had several rounds of chemotherapy and radiation. Two weeks prior to hospital admission, she had started keytruda single-agent immunotherapy and also got had a small brain lesion treated with radiotherapy in the same week. Doctors suspect there can be chemotherapy or radiotherapy-induced bone marrow damage or disease infiltration of the marrow. However, there is no reason to prove stable RBSs and WBCs and low platelet count.
Kindly advise.
Hello,
Welcome to icliniq.com.
I understand your concern and would be happy to help.
Chemotherapy and radiotherapy can damage the bone marrow. However, it is temporary and the levels get back to normal after the completion of the cycles. Meanwhile, platelet and red cell infusions are indicated. Tablet Eltrombopag and Erythropoietin can also cause long-term cytopenia's. I suggest reticulocyte and LDH tests to assess bone marrow activity. Continuous multivitamin support especially folic acid, vitamin B12, and pyridoxine can support blood cell production. Kindly share your reports for better assessment.
I hope this helps.
Thank you.
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Hematology
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