RE: Question For Medical Advisor -

[Guest guest]

Hello - hopes this helps -

To pass on:The most important question to address when the platelets are the sole abnormality is whether there is an immune component to the thrombocytopenia, e.g. ITP. This would require a slightly different treatment strategy. The bone marrow biopsy would provide the answer to that question. Performing a spleenectomy would treat ITP or hypersplenism causing thrombocytopenia, but it is better to try to avoid the spleenectomy if possible.Regarding the lymphopenia (low lymphocytes), they are low because they are either: 1) staying in the spleen; or 2) the chemotherapy directed at the CLL will also attack them, since they are very closely related. The only thing that needs to be done is to maintain the prophylaxis for patients with lymphopenia. This is typically Bactrim for PCP pneumonia and acyclovir (or Valtrex, Famvir) to prevent shingles.

[Guest guest]

and Medical Advisor

Thank you for the reply. I believe

that I can rule out ITP or any other complications as I am fairly confident

that this would have been picked up on previous BMB. I should add that

the platelets issue has been with me since early diagnosis in 2000.

I have got to make my mind up, in 2007, as

to whether I not have my spleen out or not. Not an easy one, as there is

not much information or data around and I obviously don’t want to make

the wrong decision.

Interesting point from the medical

advisor, and I had not thought of this before, but my spleen is not only harboring

my platelets, but also my lymphocytes. In this case removal of the spleen

will push my lymphocytes into the peripheral blood, I will then be like a more

classic case CLL’er and have a high white cell count.

I am seeing my Hematologist next week and

I have a lot of respect for his opinion, so some more questions for him.

Not easy making these decisions.

Regards

8 robert@...

8 www.charitydalek.co.uk

From: [mailto: ] On Behalf Of jb50192@...

Sent: 15 December 2006 20:33

Subject: Re: Question For

Medical Advisor -

Hello - hopes this helps -

To pass on:

The most important

question to address when the platelets are the sole abnormality is whether

there is an immune component to the thrombocytopenia, e.g. ITP. This

would require a slightly different treatment strategy. The bone marrow

biopsy would provide the answer to that question. Performing a

spleenectomy would treat ITP or hypersplenism causing thrombocytopenia, but it

is better to try to avoid the spleenectomy if possible.

Regarding the lymphopenia

(low lymphocytes), they are low because they are either: 1) staying in the

spleen; or 2) the chemotherapy directed at the CLL will also attack them, since

they are very closely related. The only thing that needs to be done is to

maintain the prophylaxis for patients with lymphopenia. This is typically

Bactrim for PCP pneumonia and acyclovir (or Valtrex, Famvir) to prevent

shingles.

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[Guest guest]

-

From MA:

Just remember, having a higher WBC does not carry any significance and should not factor into your decision regarding a spleenectomy.