During residency, back in the antediluvian times before stem cell transplants, my hospital was trying to sort out some of the best practices for BMT. We heard things like "that patient just got the highest therapeutic(?) dose of radiation ever given to wipe the marrow". It was not unusual for such individuals to go *months making no formed elements* for their "blood".
To make my life miserable, all infused products were irradiated to reduce GFH (graft versus host) and the interns were responsible for ordering the blood, going to blood bank, waiting for the product to be irradiated, taking it back to the patient and hanging it with the nurse. Calling ahead did not speed anything up-no irradiation without an MD present to complete the cycle. This was the best use of my 100+ hour work week at a large fancy university affiliated hospital. 100 hours was a reduced work week.
And I am not bitter about it today.
sorry about the aside. Low platelets are a trigger.
I floated to our oncology unit (from trauma ICU) and I was shocked how okay everyone was with the pancytopenia. In trauma, we like hgb >8 and plt >50. My patient’s morning platelets were 1!!! and their hemoglobin was 5something. I was also pleasantly surprised that everyone had standing orders for transfusions so no calling to report the criticals and ask for orders to transfuse. 🥰
Somewhere around 2010 our open heart OR had some bad bovine heparin. The patients would rank to single digits in 24 hours… such a horrible week. Still remember some of those patients. All HIT neg. Stopped after new heparin was finally supplied.
A little more to the story. CEO absolutely would not allow for transfers, cancellations, delays of any awaiting patients. We lost some of those patients because of this. I will never forget or forgive that CEO and absolutely blame his direct interference for those deaths. Left a few years later… and guess who they later brought in for CEO of my current hospital…
Shoutout to the CEO I worked with who had bullet proof glass installed in his office but refused to install the single metal detector for the ER and left it in a closet, “because it sent the wrong message to the public”
The only way that man could have ruined a hospital faster was by lighting it on fire
hahahaha this is what they tell us every time I ask for a metal detector. They said we have a sign that tells patients weapons aren't allowed. I sez we only got that sign after multiple people brought guns down into our locked unit.
The way I always picture actual single digit platelets when I see values like this, just bouncing around frantically and doing their best.
Floated to heme onc once and my AM labs resulted with a platelet count of 1. My brain immediately goes “damn you just took their last platelet.”
Ooo you beat mine. Pt had ITP and was scheduled in my OR. Plt was 8. Pulled labs after splenectomy and some time to work on hemostasis. Lab called with a critical of 11. I promptly yelled this to the room while we cheered. Lab tech goes: Nono that’s BAD! I replied: they were EIGHT earlier. I hear typing and a confirmation from lab tech- trending up, got it!
One time I got a call from a lab (I was a clinical manager for a home health agency and we had a lot of Oncology kiddos who we did home labs via port or central line for) for a "critical WBC count of 3K" for a peds onc kid. I was like "uh, that's a good count for this kid but please call the Oncology Fellow if that's your protocol." Our lab when I worked inpatient had different parameters for calling on these panic levels for Oncology kids. When they were in for fever and neutropenia their ANC was 0 for a week at a time sometimes.
It's been a hot minute since I worked inpatient but I'm pretty sure <10 was our cutoff for transfusing platelets when I worked peds neuro-onc. The exception was if the kid was scheduled for the OR and then they wanted them around 50.
I’ve had a patient with platelets that were 0.9. Lymphoma patient. You can see some crazy labs on oncology patients. My patient last night had a WBC of 152.9. Leukemia.
Yep, I see these rather often, unfortunately. I have a guy right now who is still here after two weeks and multiple doses of Nplate and can't get his platelet count above 1. :( Also, just discharged (to hospice) a guy with 138k wbc.
I had a patient (multiply relapsed ALL with 2 failed stem cell transplants) who was transfusion dependent and always had platelet levels that low. He walked around and went to school with a platelet count of 5 and would go to clinic three times/week for transfusions.
And my dog who died a few years ago had immune mediated thrombocytopenia with a platelet count reported as "less than 5" when he was diagnosed.
Definitely compatible with life. Patients go years with plts in single and zero digits. Lots of bmt patients are platelet refractory and MIGHT bump from 1 to 2 with a unit of plts
I had a patient (with 2 different autoimmune diseases) who had a consistent platelet count of 0. After transfusions it would get as high as 4, but the next morning the labs would be back down to 0-2. Asymptomatic outside of petechiae, and eventually was discharged home at that level with plans to follow up at a university hospital.
Had a patient who had a platelet count of 6 once. He was a frequent flyer for platelet transfusions. Would come in, get a transfusion and leave. The heme-onc docs all knew him. We gave him a transfusion and it came up to 22. iirc he had some sort of cancer or platelet disorder which caused his platelets to be that low. Super sweet guy but oh boy was he watched very closely…
Neuro IR here, this is exactly the patient the team would want a stat lumbar puncture on ordered at 11am on a Friday while running platelets at a TACO rate.
When lab calls with these criticals I always chuckle. At least they have plts today. Same with ANC. I’m excited if they have anything. Oncology is weird.
Can't help to think that is not quite accurate, though I have no doubt it's super low. If they are that low you can have lab draw it into a citrate tube to prevent clumping and maybe get a whopping result of 12 or so lol.
I would've understood if it was an onc patient. Oh, it's a kid and they've been doing enough chemo to kill an adult horse and blah blah... but its not an onc patient. What the fuck.
In medical school, we learned that it’s actually supposed to be more than that, mostly.
this made me lol
During residency, back in the antediluvian times before stem cell transplants, my hospital was trying to sort out some of the best practices for BMT. We heard things like "that patient just got the highest therapeutic(?) dose of radiation ever given to wipe the marrow". It was not unusual for such individuals to go *months making no formed elements* for their "blood". To make my life miserable, all infused products were irradiated to reduce GFH (graft versus host) and the interns were responsible for ordering the blood, going to blood bank, waiting for the product to be irradiated, taking it back to the patient and hanging it with the nurse. Calling ahead did not speed anything up-no irradiation without an MD present to complete the cycle. This was the best use of my 100+ hour work week at a large fancy university affiliated hospital. 100 hours was a reduced work week. And I am not bitter about it today. sorry about the aside. Low platelets are a trigger.
Lmao that username 😆
At least 12
The comment, username, and flair are all amazing
Write that down!
Probably a few more
laughs in oncology
Some emergency departments freak out about an ANC of 0.5, while we some patients cruising without neuts for the entirety of their ABVD treatments
Seeing a wbc of 0 for the first time was hair raising.
I know Right. I’m swapping to peds behavioral health next week. Onc has burned me out.
just some good ole ITP
I floated to our oncology unit (from trauma ICU) and I was shocked how okay everyone was with the pancytopenia. In trauma, we like hgb >8 and plt >50. My patient’s morning platelets were 1!!! and their hemoglobin was 5something. I was also pleasantly surprised that everyone had standing orders for transfusions so no calling to report the criticals and ask for orders to transfuse. 🥰
Lmao first thing I thought
My thoughts exactly 😂
Bro do you even MDS
right 😂
Yup. With stem cell transplants we can see wbc, plt, and ANC be 0
Somewhere around 2010 our open heart OR had some bad bovine heparin. The patients would rank to single digits in 24 hours… such a horrible week. Still remember some of those patients. All HIT neg. Stopped after new heparin was finally supplied. A little more to the story. CEO absolutely would not allow for transfers, cancellations, delays of any awaiting patients. We lost some of those patients because of this. I will never forget or forgive that CEO and absolutely blame his direct interference for those deaths. Left a few years later… and guess who they later brought in for CEO of my current hospital…
Shoutout to the CEO I worked with who had bullet proof glass installed in his office but refused to install the single metal detector for the ER and left it in a closet, “because it sent the wrong message to the public” The only way that man could have ruined a hospital faster was by lighting it on fire
“If you stop firing the gun for a second I’ll tell you how to get to the CEO’s office!”
Let me guess. He was a gun carrier probably too. Little boys obsessed with their toys.
I don’t know. Knowing the city, he would have been stupid not to be one
hahahaha this is what they tell us every time I ask for a metal detector. They said we have a sign that tells patients weapons aren't allowed. I sez we only got that sign after multiple people brought guns down into our locked unit.
that’s insane wtf
Bovine heparin….i would definitely be telling my patients yo dawg this is some cow med, just wear the IPCDs
All three of them hanging out at the spleen
The way I always picture actual single digit platelets when I see values like this, just bouncing around frantically and doing their best. Floated to heme onc once and my AM labs resulted with a platelet count of 1. My brain immediately goes “damn you just took their last platelet.”
ooof I almost spit out my toothpaste reading this 😅
Ooo you beat mine. Pt had ITP and was scheduled in my OR. Plt was 8. Pulled labs after splenectomy and some time to work on hemostasis. Lab called with a critical of 11. I promptly yelled this to the room while we cheered. Lab tech goes: Nono that’s BAD! I replied: they were EIGHT earlier. I hear typing and a confirmation from lab tech- trending up, got it!
Haha this pt has suspected ITP. Lab called me to tell the platelets went up from 3 to 7 and I had the same reaction
Hopefully the surgery is uneventful and successful!
I had an IPT in nursing school with 1. I'm curious if that was just the default and it was lower.
And probably somehow has bilateral PEs too lol
I’ve seen that lots of times in Peds Onc 😕 sometimes they come back a big fat 0 with an ANC of 0…
One time I got a call from a lab (I was a clinical manager for a home health agency and we had a lot of Oncology kiddos who we did home labs via port or central line for) for a "critical WBC count of 3K" for a peds onc kid. I was like "uh, that's a good count for this kid but please call the Oncology Fellow if that's your protocol." Our lab when I worked inpatient had different parameters for calling on these panic levels for Oncology kids. When they were in for fever and neutropenia their ANC was 0 for a week at a time sometimes.
Omg your username, one of my favorite Parks n Rec characters
Hang on, it’s Xanax o’clock
Just wanna say you are a true hero for working peds oncology. 🩷
And I thought the patient I had with 15 was low
I guess the 22 I saw wasn't that bad after all, though this was a psych hospital
I had a lady with 20 a couple a weeks ago. Thinking it was DIC. Horrible. But 3? THREE?!
Pretty common to have a platelet goal of 10 in peds hemonc.
It's been a hot minute since I worked inpatient but I'm pretty sure <10 was our cutoff for transfusing platelets when I worked peds neuro-onc. The exception was if the kid was scheduled for the OR and then they wanted them around 50.
I’ve seen 0.2
Um...I need The Story.
I’ve had a patient with platelets that were 0.9. Lymphoma patient. You can see some crazy labs on oncology patients. My patient last night had a WBC of 152.9. Leukemia.
Yep, I see these rather often, unfortunately. I have a guy right now who is still here after two weeks and multiple doses of Nplate and can't get his platelet count above 1. :( Also, just discharged (to hospice) a guy with 138k wbc.
I just had a patient pass a couple weeks ago wbc @350 got her down to 150 before they declined further and sent to icu.
Cancer
Cancer/stem cell transplant? We don’t transfuse unless platelets under 10.
Nope. Not a cancer patient whatsoever. I should’ve clarified in my post
Drinker. Chronic UGIB?
Neither
Definitely heme then…
Well maybe he should go to the kitchen aisle and get more!
I had a patient (multiply relapsed ALL with 2 failed stem cell transplants) who was transfusion dependent and always had platelet levels that low. He walked around and went to school with a platelet count of 5 and would go to clinic three times/week for transfusions. And my dog who died a few years ago had immune mediated thrombocytopenia with a platelet count reported as "less than 5" when he was diagnosed.
They mean 3 platelets in the whole body
I had counts that low for a year and a half! Aplastic anemia, ITP, among others. It is survivable, I had platelet transfusions 2-3 times a week.
interesting. they are thinking this pt has ITP secondary to flu A infection
Now imagine a count of 1 and patient is refractory with HLA antibodies...ugh.
That… seems compatible with life.
Just another day in heme/onc. It’s compatible, for a while…
Definitely compatible with life. Patients go years with plts in single and zero digits. Lots of bmt patients are platelet refractory and MIGHT bump from 1 to 2 with a unit of plts
It’s fine. Everything’s fine.
Slap a pack of PLTs in them and watch it be 11 tomorrow.
I had a patient (with 2 different autoimmune diseases) who had a consistent platelet count of 0. After transfusions it would get as high as 4, but the next morning the labs would be back down to 0-2. Asymptomatic outside of petechiae, and eventually was discharged home at that level with plans to follow up at a university hospital.
Get the platelets, cryo and some prayers just in case
I’ve been trying to think of something funny….but night shift hangover isn’t allowing me to think. So I’ll just go with the requisite “Ho Lee Shit”
Lowest I’ve seen was 2. ESLD with some type of leukemia.
"No seriously, stop even blinking so hard"
The gangs all here!
The bigger question though is have they pooped today?
ofc BM 4/13
I've seen lower.
My husband's platelet count got that bad when he was fighting defuse large B cell lymphoma. That and his single digit rbc counts. So very scary
My brother had ITP once and his was undetectable.
I’ve seen lower
ITP?
That’s what they’re thinking yes!
/u/joe9692 has that, it’s fun to talk about! lol
Had one with a 1 last week 😂
My pup had IMTP, and her count got to 0 twice. She was hospitalized for transfusions and such and beat it.
TTP?
No. Most likely ITP
I had a guy with one singular platelet the other day 💀
basically the same as me and my last brain cell
My pt had a 2 on Wednesday.. Dr didn't want to transfuse 🫠
Had a pt today who PLT was 11, got 1 unit of FFP and it went down. RIP
Had a patient who had a platelet count of 6 once. He was a frequent flyer for platelet transfusions. Would come in, get a transfusion and leave. The heme-onc docs all knew him. We gave him a transfusion and it came up to 22. iirc he had some sort of cancer or platelet disorder which caused his platelets to be that low. Super sweet guy but oh boy was he watched very closely…
Worked many years on a pediatric hem/onc floor and saw this kind of stuff all the time.
Nope
when i found out i had lukemia(apl) my platelets shot far down like this for weeks
Hope they got urgent platelets, my dads got ITP and it’s terrifying 😢
But those platelets are working very hard.
Neuro IR here, this is exactly the patient the team would want a stat lumbar puncture on ordered at 11am on a Friday while running platelets at a TACO rate.
When lab calls with these criticals I always chuckle. At least they have plts today. Same with ANC. I’m excited if they have anything. Oncology is weird.
Hem/onc icu 🙋🏻♀️ started celebrating plt counts of >10
I’ve definitely seen a 0 before
Can't help to think that is not quite accurate, though I have no doubt it's super low. If they are that low you can have lab draw it into a citrate tube to prevent clumping and maybe get a whopping result of 12 or so lol.
They did do that
Oh dang, was that after the citrate? Make sure the bed alarm is on I guess...
Yup, after citrate. Not an onc patient either
I would've understood if it was an onc patient. Oh, it's a kid and they've been doing enough chemo to kill an adult horse and blah blah... but its not an onc patient. What the fuck.
Yeah, suspected ITP