Karin - you sort of have the idea. Platelets do have markers on them which are activated in the course of constructing a blood clot. In situations such as MPD, and ET in particular, these platelets may have their markers already activated so they are much more likely to clot - especially in small blood vessels . What aspirin does is prevent the platelets from making one of the compounds that activate platelets so that the platelet looks ok but simply cannot become active under any circumstances.
Because blood clots are a combination of platelets stuck together (platelet aggregation) and fibrin, another way to prevent/slow down/lessen a blood clotting episode is to block the creation of fibrin. The most common way to do this is with an anticoagulant. Cureently there are two major ones on the market: heparin and coumadin. Heparin interferes with the ability of 2 enzymes that are needed to make fibrin while Coumadin lessens the production of 4 other enzymes involved in the same process.
Plavix is quite new and works on the platelet side of the blood clot process by preventing them from adhering to each other.
You are correct - it is the balance that is the key. Aspirin and Plavix will both cause petechiae. Coumadin will cause much more extensive bleeding since it is the fibrin that actually "makes" the blood clot.
Lots of other folks have bruising with plenty of platelets. It is called a qualitative platelet defect. Some of these are hereditary; some acquired. Almost none of them are primary disease states in that something else always causes the platelets to go out of whack . Medications are a very common culprit. Some people can get black eyes - just be bending over and allow blood to pool in the delicate capillaries around the eyes! We don't have many other alternatives so I am sure that you and your physician will have a loooooong conversation about how to protect yourself from potentially serious bleeding situations.
Denise, for platelet counts of below 20 there are only 3 choices = holding your breath and waiting, platelet transfusions or a synthetic platelet stimulating hormone similar to EPO for red cells.
If reverse order - platelet hormone can work wonders on some people. However, there have been a lot of reports of people's platelet counts going through the roof (2-3 million) when using the standard dosage so it apparently does not work well on everyone and you simply don't know which one you are going to be until after you have tried it.
Platelet transfusions can get you through short time issues but should not be used for prolonged correction since 1) you get antibodies to platelets making future use problematic and 2) you can get blood borne diseases such as hepatitis so transfusions are only done when there really isn't another choice.
Waiting - especially if you are going to use neupogen - is the conservative approach unless you are bleeding somewhere. Not only will your WBC count go up, there is a boost to the platelet producing cells as well. Making sure that you are eating a balanced diet also helps, since you will have to make a lot of platelets to catch up and they will need nutrients such as iron, B12, folate, etc.
In the meantime - don't shave! ;-)
Itis true that Fludara will definitely drop his platelets. Having said that - it is also equally true that all oncologists already know this and frequently use platelet transfusions in situations in which there is a suspicion of bleeding.
As to the postponed surgery, did the surgeon know of his CLL? I find it amazing but it is true that in many situations physicians don't talk to each other (at all or well enough). While low platelets is a concern for any surgery, platelet transfusions might just get him through this.
One of the functions of the lymphocytes is to produce agents that stimulate other cells to divide or mature or function in some ways. When they are all taken out by immunologic therapy, their production of interleukins will obviously drop as well. Then, when the interleukins start being produced, one of the cells which will be targeted is the progenitor cells for red cells, granulocytes, monocytes, and platelets. Increases in each of those in the blood stream will occur depending on the time it takes them to mature and platelet mature more slowly than the others.
Second - if you have ITP, then all bets are off on normal recovery. ITP is caused by an antibody which you form against platelets. Any additional platelet that you get from a transfusion will be coated by the same antibody and removed from the system just as your own platelets are removed. Standard therapy for this is either prednisone to stop the production of the antibody or splenectomy to remove the site which takes the coated but still functional platelets out of the blood stream.
Giant platelets are platelets that have been released from the marrow prematurely. They do function normal so neither bleeding nor clotting improperly are a problem. But they and the low reds are signs that the marrow is stressed.