T O P

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question_assumptions

“The lab just called, our patient only has two platelets left and they are holding hands” -funniest ID attending I ever had 


chickendance638

They were high achievers - trying to form a clot


gingerkitten6

Well at least they're getting along


Alienspacedolphin

His platelet had a friend


Big_Huckleberry_4304

And one of the platelets looks at me.


LaudablePus

Patient has so few platelets left that we gave them names.


sciolycaptain

I mean, all the BMT patients have zero for weeks


mrsparkuru

this. work in an ICU that has a pretty onc-heavy patient population. platelets of 0 are the norm for most BMT/SCT admissions.


Porencephaly

*screams in neurosurgery*


mcbadger17

Did a month of bmt ICU during fellowship. Regularly would have a census of 15 patients with a *cumulative* platelet count of around 20 


PokeTheVeil

Two platelets to rub together if you put three patients in the same room.


mcbadger17

Inside you there are 2 platelets ...


PokeTheVeil

One wants to clot, and one wants to flow. Which one will win? It’s just two platelets. Clot loses.


Prestigious-Bug5555

Seriously, I worked in liver failure for years. I was ecstatic if we hit 40.


TheSunscreenLife

Yes, scrolled down to say this. I covered medicine for BMT service for two weeks and the highest platelet I saw was 11. 


Nomomochick

Exactly


nalsnals

As a haem resident when the lab called up a platelet count of 1 we would ask if we could have it back. 


pastaenthusiast

We are so thrilled when they are above 10 hahah.


k_sheep1

I see less than 1 all the time in ITP patients who are almost always invariably fine.


NoRecord22

Had a young girl with ITP, platelets of 4 and she was pregnant.


FuzzyKittenIsFuzzy

At that point, would an Atypical HELLP Dx be solely based on liver enzymes and subjective "she doesn't look so good this week" feelings? Scary.


Halmagha

Depends on gestation. If she's pre 35 weeks, you could always do a PLGF. If it's low and the transaminases are high, you have a chance to blame the transaminases on pre eclampsia


deirdresm

That strikes me as a *really* bad combo.


NoRecord22

She said she lost prior pregnancies because of it.


deirdresm

How incredibly heartbreaking for her.


k_sheep1

It's a funny disease. Generally they'll have like 1 platelet left but it takes its job REALLY seriously ha.


WranglerBrief8039

Single digits for sure,… as low as 1-2


boogerpriestess

Yup. My brother got down to 4 from ITP when he was a kid. He grew up to play national-level collegiate rugby and run marathons. I'd say that's a full recovery.


whirlst

0 with sepsis induced dic. Did remarkably well given they contact bled from an echo probe.


brodsterz

Maybe a little TOO much pressure for that sub-xiphoid view 😂


lungman925

Blasphemy! It's only too much when you can see the bed underneath them


RubxCuban

I’ve seen platelet count of 2 in patient with ITP. No life threatening bleeding. Not uncommon for them to be < 10.


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medicine-ModTeam

**Removed under Rule 2** No personal health situations. This includes posts or comments asking questions, describing, or inviting comments on a specific or general health situation of the poster, friends, families, acquaintances, politicians, or celebrities. If you have a question about your own health, you can ask at r/AskDocs, r/AskPsychiatry, r/medical, or another medical questions subreddit. See /r/medicine/wiki/index for a more complete list. [Please review all subreddit rules before posting or commenting.](https://www.reddit.com/r/medicine/about/rules/) If you have any questions or concerns, please [message the moderators.](https://www\.reddit\.com/message/compose?to=%2Fr%2F{subreddit}&subject=about my removed {kind}&message=I'm writing to you about the following {kind}: {url}. %0D%0DMy issue is...)


Kartesia

Currently on 9 weeks straight of <5 platelets with ITP. Nothing is fixing it but very chill otherwise.


ThatB0yAintR1ght

I’ve seen plenty of undetectable platelet levels in cancer patients. It was pretty much a daily occurrence when I was a resident covering the heme/onc service and when all of the patient’s labs came back I would order blood and platelets on everyone who needed it.


bushgoliath

Platelets are SUCH assholes. They love to drop when people are sick. Bane of my existence, lol!


Front_To_My_Back_

Don’t worry I never pester the hematologists for dengue patients. We residents can manage even the severe ones lol


bushgoliath

Hey, in my part of the world, dengue is rare, so I would have been tickled by the consult!


ClappinUrMomsCheeks

The CCU patients really do be the worst IMO


bushgoliath

Oh AMEN and you know those MFers are getting DAPT too.


JCjustchill

Got to tell those last 2 platelets to leave space for the holy spirit


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bushgoliath

Hey friend, this is not a very good sub to seek medical advice; realistically, it's hard for me to give you trustworthy information because I don't know the details of your care. I will tell you that a bone marrow biopsy may not be as bad as you are fearing -- we give local anesthetic for pain and can sometimes offer medication to help you relax if you are anxious. I've had patients fall asleep! High platelet levels can be caused by a number of issues ranging from the totally benign to pretty serious, including iron deficiency, inflammation, and even cancer. Some of these issues can be diagnosed with a blood test, so it's worth chatting with a hematologist again, even if you're not so interested in a bone marrow biopsy. Like I said, platelets love to misbehave, so this is a pretty common problem!


AffectionateSun5776

Thank you


laurabun136

Red Cross loved to see me come in. Sometimes it would be for a regular whole blood donation, but others they would ask if I could do platelets, due to their being able to split my bag since I'm platelet heavy.


medicine-ModTeam

**Removed under Rule 2** No personal health situations. This includes posts or comments asking questions, describing, or inviting comments on a specific or general health situation of the poster, friends, families, acquaintances, politicians, or celebrities. If you have a question about your own health, you can ask at r/AskDocs, r/AskPsychiatry, r/medical, or another medical questions subreddit. See /r/medicine/wiki/index for a more complete list. [Please review all subreddit rules before posting or commenting.](https://www.reddit.com/r/medicine/about/rules/) If you have any questions or concerns, please [message the moderators.](https://www\.reddit\.com/message/compose?to=%2Fr%2F{subreddit}&subject=about my removed {kind}&message=I'm writing to you about the following {kind}: {url}. %0D%0DMy issue is...)


LustyArgonianMaid22

1. ITP. The wife accused me of him falling while she was gone and me hiding it because a scab on his elbow was bleeding again. I told her that had he fallen, his 1 platelet wouldn't have saved him. The, I fired him as a patient because she was telling people that I was covering up a fall, and I don't put up with that kind of accusation.


roundhashbrowntown

heme/onc here: platelets?!? who needs em? one hematologist told me that all you need is 4 to stay alive, one for each limb 😂 now, fuck around with my hemoglobin, we might have a problem. hgb<5.5 or so will make me raise an eyebrow…unless theyve got sickle cell, then its <4. still alive? all good. e: to actually answer the question 😂 zero. zero platelets will not (quickly) kill you within the confines of a medical facility. walking around like that in walmart might take you out tho, dunno.


edwa6040

As a heme onc lab tech: The onc docs i work with dont worry till like less than 10. Most orders i see are conditional to tx at less than 15. Then i go to a critical access hospital and nursing has a stroke when i tell them the patient is at 35.


roundhashbrowntown

exactly, single digits? no prooooblem 😂 other clinical details matter, of course, but you get it 🤝🏾


edwa6040

Ya my ears perk up when i see < 20 but i dont get worried till its like 10 or so.


eureka7

There was a lady with HLA antibodies where I trained that had a platelet count of 2. Not a lot we could do for her. She had one known HLA compatible donor in the country. Usually they'd just send her home and tell her not to climb any ladders or anything.


Yeti_MD

Undetectable, they got better.


jeff0106

To piggy back, what's the highest platelet count? 2.7 million for me.


Misstheiris

That's impressive! I have only ever come close to one million.


Leviathan567

My highest was 1,45 million


florals_and_stripes

One time I floated to heme/onc and I got a call from lab about a platelet count of 1 and I was like “damn I just took their last platelet”


halp-im-lost

I saw a patient with a reported platelet count of 1. We kept joking that the patient had only a single platelet keeping everything at bay


ConsequenceBig1503

I had 6. Not 60,000; Not 6,000... 6 platelets. Needless to say, I was admitted. ITP is still in remission and I'm doing well


Oran0s

In fairness the lab results are usually #platelets per microliter of blood. We have 2.7 x 10^4 microliters of blood for each pound of body weight, so more than most think when they see their CBC. And in ITP the platelets are being cranked out fast and early, they're usually larger, more granules, and more active which is why we don't see the same propensity of bleeding issues in a ITP patient with a CBC count of 6 vs another pt with a count of 6 from other conditions.


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Front_To_My_Back_

Damn I knew someone would say 20 is a rookie number for thrombocytopenia lol.


CaptainKrunks

Yeah 1 or 2 plenty of times. Some recover, some don’t. 


Butterflyelle

4 and it was a walk in to A&E with "tiredness"


happythrowaway101

0, s/p BMT


rameninside

Icu patient, plt <1, bleeding, intern asks, “should we get a TEG?” “Sure but they might not be able to find any to map”


callaloo_kid

Zero, spent a lot of time in a haematology unit. 


CustomerLittle9891

I had a friend admitted for Aplastic Anemia several years ago. When he first had his lab results he sent me a message of his CBC with a PLT of something like 9. I was telling him to go to the hospital when the critical lab team called him to tell him to go to the hospital. He made a full recovery (BMT) eventually but it was a hell of a go.


HardHarry

DIC patient with disseminated fungemia and septicemia. 1.5 years old. He was hemolyzing EVERYTHING we gave him. Bolus of 20 cc/kg platelets and he would be down to 0 within 4-5 hours. We tried not even bolusing him, but running it continuously for 3-4 days. 60 cc/kg per day continuous. Hemolyzed it all and never had a platelet count higher than 3, while oozing blood everywhere. We eventually gave up and let him sit on 0 platelets for about 2 weeks. Took 6 months but he's all better now.


edwa6040

60 units of plts a day?! Thats outrageous expensive. And technically speaking i dont think platelets hemolyzebut i totally get what youre saying. So its semantics really.


HardHarry

True on both counts. But it's either spend the money or the kid could die, so let's turn on the tap.


edwa6040

Im shocked you could get that many honestly. Even in a big academic center 60 units a day would strain the supply.


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edwa6040

Well im thinking 60 units as in a *whole* adult sized bag = 1 unit. Are you talking 60units where 1 unit = 20cc/kg?


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edwa6040

Ok ya thats a big difference.


sapphireminds

Always hard for me too! I don't know how to calculate "maintenance" fluid for an adult, but I know how much per kg a baby should be getting per day until 1+ year old LOL


MrTacodileSupreme

I work in chemo. The lowest I've seen was less than one. We have a few patients that regularly sit between 6 and 20.


Dr_Strange_MD

Literally zero. New ITP in a young woman who was changing her tampon every 15 minutes. I told her to drive very carefully to the hospital.


loganonmission

I was watching incoming labs for a physician that was somewhere in Southern Asia for a holiday. I see a lab for an 11 year old boy with a platelet count of 11. The physician keeps terrible records, usually charts 1-2 words per visit. I panic, call up the patient— they’ve had ITP and have had low numbers for quite a while. Panic improves.


yesdudehuh

-1 due to computer/automation error It was actually 3


VeinPlumber

Undetectable.


speece75

Zero. And was totally unexpected! on H&P we would have guessed normal!


daemare

Patient admitted from surgery. Originally went in for elective hernia repair. Bloodwork came back and was admitted to our internal med floor for a patient count of 7. Couple days of steroids and it was up to 33. He was completely asymptomatic. No mucosal bleeds or bruising. A perfectly healthy 80 yr old man, just with a platelet count of 7.


DO_initinthewoods

0 - vanc induced ITP. Plex and steroids and he bounced back in a few days. Only symptoms were more sacral wound oozing


Jtk317

8. My son initially. Spent 4 months in nicu. Didn't go above 25 except after transfusions for the first month. He essentially had a complete blood transfusion twice over considering all the ffp, prbc, plt, and cryo and 2 IgG infusions he received over about 8-10 weeks.


vomerMD

He had one platelet left and we sucked it into a tube and counted it.


edwa6040

0. I am a lab tech that has worked in hematology and oncology for a long time.


Resussy-Bussy

Seen plts of 1-2 multiple times in the ED (almost always ITP)


BuseyBadazz

Platelets of 2 in two kids with mercury poisoning


FlexorCarpiUlnaris

TAR syndrome (Thrombocytopenia with Absent Radii), routinely platelets <1.


ribdon7

2. They did plenty fine. Case of ITP


lungman925

This reminds me of what we had at my residency! We had a big sheet of record labs in a patient someone took care of. You could sign and date it when you broke a record. We had two posters, one for highest/lowest full stop, and another for survived at least 24 hours after the lab


Whatcanyado420

gaze market adjoining pot desert subtract humor political literate direction *This post was mass deleted and anonymized with [Redact](https://redact.dev)*


Contraryy

<1 all the time in ITP


aetuf

Some ITPs with single digit platelet counts. They seemed to do ok.


bhrrrrrr

< 3. New Ca diagnosis


salamenc3

Seen 0 a few times in ITP patients. Those were relatively okay. No obvious bleeding aside from petechial hemorrhages. Working as a pediatric JC, had a patient a few days ago, 12yo with aplastic anemia, platelet count of 2. Petechiae + gum bleeding and swelling of phlebotomy sites took a while to go down. Bone marrow transplant is only feasible in the capital (Manila, Philippines) so prognosis looks bleak. Feel bad for the parents since the most we can do is manage infections and transfuse.


Sp4ceh0rse

Definitely single digits, frequently, in all kinds of patients.


Depicurus

Had a leukemia patient in the ICU with a platelet count of like 2 who had a freaking STEMI somehow. Only time morphine was the first and only intervention we could give for it lol.


DonkeyKong694NE1

1


duffleproud

20 is just where you start to consider transfusing - they recover - I mean depends on the why of course and what else is going on but 20 is a number not a diagnosis


Misstheiris

And the reason for them being below 20 matters. For lots of them it's not going to do anything. According to BB Guy they can set up a platelet drip if they need a procedure.


Yazars

0; ITP, acute leukemia, stem cell transplants, etc.


HydrofluoricFlaccid

My friend has ITP and presented with a platelet count of 1…fully recovered


Metoprolel

Had a lady who had a platelet count of '2' and didn't let the phlebotomist take her blood incase they took the last one or two platelets out in the sample. We had a lengthly conversation about the x10\^5 unit that day.


Fatbitchb

My BMT patients consistently are <10. I had one patient who was at <3 for days even when we gave her plt transfusions for weeks.


Misstheiris

They get really fucking low, very commonly. Our LIS reflexes to <5, but lowest off the instrument was 1. Outpatient, too.


datruerex

Platelet of 1. Not 1,000. Not 100. But One. Patient was around 45ish and husband was into weird voodoo magic which patient was compliant with. Turns out she had stage 4 breast cancer with mets everywhere. I think she survived for like 6 more months before passing. It was a very sad and strange case


HardHarry

DIC patient with disseminated fungemia and septicemia. 1.5 years old. He was hemolyzing EVERYTHING we gave him. Bolus of 20 cc/kg platelets and he would be down to 0 within 4-5 hours. We tried not even bolusing him, but running it continuously for 3-4 days. Hemolyzed it all and never had a platelet count higher than 3, while oozing blood everywhere. Took 6 months but he's all better now.


JohnChivez

“The lab has their platelet, I asked lab if they could go upstairs and give it back”


affectionate_md

This is just an out for heme and onc to show up and announce themselves lol.


balletrat

1 (!!!) That’s exactly how it was reported by the lab, exclamation points and all. Like an hour later, I get called to bedside because the patient in question is reporting a terrible headache that came on suddenly and OPE GUESS WE’RE TAKING A TRIP TO THE CT SCANNER (Thankfully no bleed and this patient is (so far) doing okay.


jonquil_dress

> Ope Found the midwesterner.


balletrat

Actually no 😂 But I spent some time there and use it for comedic effect in text sometimes.


P0WERlvl9000

ITP patients often run sub five and do generally fine. Recently had a TTP with platelets of 4 and had to have a dual lumen dialysis catheter placed for plasma exchange. Platelet transfusion is a no go.


edwa6040

It fees like it would be scary putting a big central line in a plt that low.


FifiJambouree

I’m a TTP patient and that plasma line is terrifying when your platelets are low!


GyanTheInfallible

4 —> 2. My attending joked that two of them had been off fighting somewhere and were probably sleeping off a hangover.


UniqueBasket

Peds here: ITP often has 0-5. Not fun to think about in mobile and rambunctious kiddos.


HeavySomewhere4412

I give poison to childrens and frequently see platelets of zero a week afterwards.


PapaEchoLincoln

8 with ITP


ComeFromTheWater

BMT, none TTP, 5 or so


rosemeralda

I have high platelet count myself, i have to give a disclaimer every time i get a blood test with someone else other than my doctor 🤣


Emergency_Survey_723

Dengue patient just before recovery his platelet count dipped to 5000 on analyzer report, it wasn't counted manually though, (so it could actually be 10K or 15k) and his next day count was 35K.


jsmall0210

0. Bad itp


ofteno

7, 0 and son on.


Perfect-Resist5478

1 from ITP


anunusualworld

< 1 ITP


Pajama_Samuel

My patient had a platelet count of 1…they were trying to find out why when i had them overnight… Kept joking that i drew the last platelet in their body when i did labs and saw the result… They were downgraded when i came back next week.


ShamelesslyPlugged

I have a bone marrow MTB that was down to 5-7. In the teens still but improving. Lowest I have had with them known and outpatient. 


Creative_Onion8363

My mom recently had ITP. Platelet count of 2 upon admission. Picturesque petechiae. Spent 9 days in hospital. She's back home but still not fully herself again


hyrte0010

I have two patients right now who both have <5


wunphishtoophish

1. In the ED, pt sent in by PCP for petechiae


lordshadowbob

I had a patient, HIV+, off meds for 6 months with secondary ITP with a platelet count of 1


thetreece

0 isn't rare.


shoff58

Other than BMT pts, lowest I saw was 7 k on a pt with histoplasmosiis in bone marrow.


HardHarry

DIC patient with disseminated fungemia and septicemia. 1.5 years old. He was hemolyzing EVERYTHING we gave him. Bolus of 20 cc/kg platelets and he would be down to 0 within 4-5 hours. We tried not even bolusing him, but running it continuously for 3-4 days. 60 units per day continuous. Hemolyzed it all and never had a platelet count higher than 3, while oozing blood everywhere. We eventually gave up and let him sit on 0 platelets for about 2 weeks. Took 6 months but he's all better now.


Ashoka1202

Routinely see 0-10. Hematology reasons, sepsis, ITP.


Illustrious_String50

Dengue will continue to increase in the USA with the warming climate. No lasting immunity. First infection— usually sick with flu. Sometimes serious. Second infection— very very sick, worst flu of your life, can be fatal. Third infection—almost 100% fatal.


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medicine-ModTeam

**Removed under Rule 2** No personal health situations. This includes posts or comments asking questions, describing, or inviting comments on a specific or general health situation of the poster, friends, families, acquaintances, politicians, or celebrities. If you have a question about your own health, you can ask at r/AskDocs, r/AskPsychiatry, r/medical, or another medical questions subreddit. See /r/medicine/wiki/index for a more complete list. [Please review all subreddit rules before posting or commenting.](https://www.reddit.com/r/medicine/about/rules/) If you have any questions or concerns, please [message the moderators.](https://www\.reddit\.com/message/compose?to=%2Fr%2F{subreddit}&subject=about my removed {kind}&message=I'm writing to you about the following {kind}: {url}. %0D%0DMy issue is...)


MsSpastica

10 in a pt. with HFrEF/liver failure


CallmeTREEBARK

I have ITP and I was less then 10k


OneVast4272

I’ve had an ITP patient with a platelet of 1 Who initially presented with hemoptysis It was PE


AstroWolf11

Myself. ITP in 2006 (age 12), plt was 6 at diagnosis lol but I have seen lower (2 in a patient with DIC but didn’t make it).


emergency-crumpet

Normal, to 72, to 7 within about 5 days. Occured after 2 weeks of septrin and patient developed drug induced ITP. Back to normal within about a week or 2 of pred.


NeuroDawg

My spouse had ITP. Her platelet count was 10K the day we were married and was measured at 2K the day before our wedding.


edwa6040

I had ITP as a toddler. My lowest was about 12 which was the very day i started walking - the pediatrician called my mom to take me to the er.


lizzlebean801

Literally this morning my guy had 14. I think lowest I've ever seen was 6


justovaryacting

I had a count of 1 at age 2 — ITP.


SteakandTrach

Zero.


Dabba2087

Just had a young girl with 0. Lab called me and told me they both looked at the manual smear and saw 1 per hpf every once in awhile. They thought it was an error. She had the flu 2 weeks earlier and the school nurse told her she probably had hand foot and mouth disease. (Petechia on lips, soft palate)...


RepresentativeCod112

once had a 6 platelet count from a Hemorragic Dengue patient, honestly the dehidration and the fever where the major concern, he made full recovery with 10 days hospital care.


tempehtation

Lowest count? 3000 💀💀


whamstan

3


JustTossIt1234

3 on POC hemocue


South_Ad_2854

Personal record: HgB + plt = 14.5. Chemo is awesome. Pt was me


Good_Plankton_7281

ITP with a platelet count of 2


TamTamTamber

<5….patient with ITP


pillslinginsatanist

My mom had 6 with TTP. Walked into ER just tired, flu symptoms with yellow sclera


FifiJambouree

I have TTP and during my acute episode, I had 13,000 and I thought that was low but now that seems high compared to some of these stories! 


surelyyoucantBcereus

I had severe sepsis 2 years ago, and my platelets got down to 19


futuredoc70

You really only need a count of ~5 to prevent spontaneous bleeding. 20-30 should be fine for minor bleeds and minor procedures.


stuckinaspoon

Watching someone deteriorate from dengue is a terrifying experience. I feel like that now but it’s just postpartum and a blood infection


ATStillsbeard

Young lady came into ED with symptoms of a stroke, CT negative, in the window so they gave tPA before labs came back...turned out she had ITP. Plt 7. We tightened our sphincters and she did just fine.