How low will they allow platelets to go?

I’m curious as to how low doctors will allow platelets to drop. Latest blood work has them at 27. My current MELD is 14 last I checked.

Anybody with experience of very low platelets?


If your Platelet count is truly 27, I think you have great concern to address this as soon as possible with your hepatologist. That is seriously low in my opinion. The normal Platelet count range is 150-450x10^9/L. At my most sickest time just before my transplant my platelet count was only 72. Please get that verified and checked out soon.

PSC 2011 / Liver Transplant 7-2015

Thanks for the quick reply Mark.

I’ve been a long time lurker here hit only signed up today. I’m familiar with folks getting confused about results and terminology ect.

Not the case here.

My plaletes have been trending downwards for years.
Aug 2016 - 38
Dec 2016 - 35
Jan 8th 2017 - 35
Feb 14th 2017 - 27

I am seen regularly by my hep and my the Pre-Transplant team, though am not listed. They will revisit in 6 months unless something changes.

I see my Hep on Monday.

Was just curious how low it can go.


I received one platelet transfusion, but I do not recall what my number was. I received a living donor transplant in February 2012.

A platelet count of 27 should get your doc worried. A count of 10 or less can be life-threatening. I am not sure at what point a platelet infusion would be considered, but you’re probably getting somewhat close.

Mine hit 62 in November after declining for a while but bumped up to an 88 in January.

Thanks for all the responses.

I am quite curious as to what he will say on Monday. I wonder if there are exception points for low platelets?

Like usual I am caught in between wanting to last as long as I can without transplant and not wanting some byproduct of the disease to get me!


Let us know how things go with your doctor Monday. What he tells you may help others here on this forum who are going through similar circumstances. Hopefully they can get a handle on this soon. Take care.


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I’m with Mark on this one… 27 is very low and it would be advisable to get checked out. From experience though, I know some hospitals don’t consider platelet transplants until well below 20. Below 10 you are at highest risk of spontaneous internal bleeding which can be very dangerous.

My platelet count suffered a fair bit while I was on chemo last year but even at my lowest I was only at 45. I couldn’t have chemo when platelets were below 75.

Thanks for all the replies. I am now more interested than I was to see the response for the good doctor. Though my money is “don’t fall down and promise me not to do anything dangerous”. But we shall see.

Does an enlarged spleen return to normal healthy size post transplant?


Regarding your question of an enlarged spleen. I was told by my transplant doctors that the spleen would not return to it’s normal size post-transplant. But…since you would not have the high portal hypertension pressure any longer bearing down on your vital organs the danger will be eliminated. That’s the understanding I have and I asked the same question post-transplant as well.


Saw the doctor today…long story short…Platelets are very low. Nothing can stop it except transplant. Timing becomes the issue. 27 is not the time. Under 20 they seriously look at it as an option.


Are they speaking of Platelet transplant (?) or liver transplant? I do hope they are going to start checking your labs more frequently with the numbers so close together.


Liver transplant. They say at this stage a platelet transplant would only be good for a few hours until the spleen eats them up. Continue to check labs every three months. Still think three months is too long?

Correction - blood mid March and then every three months.

If you are continuing to feel poorly with your PSC I would consider asking your hepatologist to present you to transplant board at your hospital for placement on the transplant list. I was listed with a MELD of 12 but 6 months later I ended up with a MELD of 36 and a liver transplant. I know there are so many factors that go into the decision like an increased bilirubin level and increased frequency of ERCP’s showing further scarring, etc. Stay on top of things though and don’t give these doctors any rest if you continue to feel more poorly. You are the one that will know when things are really starting to get bad! Take care and stay in touch.


The cause is cirrhosis and splenomegaly. Just like your doctor said, your enlarged spleen is eating your platelets. But keep in mind, the number does not tell the whole story. What matters is the number and the function. You never mentioned anything about spontaneous bleeding or bruise. I assume you don’t have them. Then, it’s bad, but not that bad. There is no reason to go for liver transplant just because of that since your reading has been low for quite a long time. If you’re in immediate risk of bleeding or having bleeding problem now, platelets transfusion can solve the problem temporarily.
As to how low they will let your reading drop, it’ll be considered low enough when you show signs of bleeding or you need a surgery, IMO.

Appreciate your response. I do bruise easily and have occasional bleeding nose, but rather mild - more like I blow my nose and it will have a slow bleed afterwards. I had an unexplained bleed internally, they couldn’t locate it, in June - which pushed my hemoglobin to 58. A blood transfusion and iron made me a new man!

Agree that there is no reason to transplant solely based from the platelet number. I presume my worry is that it will creep lower and then intersect with some type of bleed with then cannot be controlled due to the low platelets. The chicken or the egg conundrum. Also, curious how a major operation, transplant, could be done down the road under such conditions.

As an aside, I really enjoy and appreciate the discussion here.


Bleeding nose may not be the real thing. You may have some vascular issues and blowing your nose simply breaks it. Your low platelets then will make it difficult to stop. What you need to watch for is the spontaneous bleeding.
When you have a sudden drop of hemoglobin. The most common reason is GI bleeding. You will need both upper and lower endoscopy, sometimes capsule endoscopy to look at small intestine, or even interventional radiology. And if the bleeding won’t stop, there will be transfusion and other approaches. I don’t think doctors do prophylactic transfusion just because your numbers are low. Remember, blood product has its own risk.
Don’t worry too much about your platelets. It’s a dangerous world anyway. Keep an eye on any new bleeding signs. As I mentioned before, if you really need urgent surgery like transplant, transfusion will help you out.

There is another surgical option, splenectomy - remove your spleen. It has its own risks.

They stated they would transplant liver over removing spleen. Risks would be greater in the removal of spleen in my current state.