Doing phlebotomy can increase your platelet count!

[maldorf]

Quite of few people will experience a high hematocrit when on AAS. This is anything over about 55 hct. The condition is known as polycythemia. I was looking into it some more tonight since I am now having trouble with this during my HRT. Mine is now up to 56 and my endo is going to have to decrease my dose of test. This is not a good thing since I felt like shit when on just 100mg/wk. Im now on 150 mg/wk and feel better than I have since last July's heart attack.
I also read about Big Bapper's death to a blood clot and remember reading his comments on how he was doing his own phlebotomies. I too did some. In fact I did one less than 1 week before I had that massive heart attack and almost died myself.
It turns out that drawing blood like that can actually increase your platelet count and increase you chances of having a clot short term! Me doing that big blood draw could have been what pushed me over the edge. here is a quote for the article I read:

"Because phlebotomy may increase the number of platelets and does not reduce the size of an enlarged liver or spleen, people who undergo phlebotomy may need drugs to suppress production of red blood cells and platelets. Hydroxyurea Some Trade Names
HYDREA
, a chemotherapy drug, is frequently given, but when used for many years there is concern that it may increase the risk of transformation to leukemia, although this risk has not been proven. Alternative drugs for lowering the number of platelets, such as interferon-alpha and anagrelide Some Trade Names
AGRYLIN
, are sometimes used in younger people who may need treatment for long periods. Some people are given radioactive phosphorus intravenously, but doctors restrict this type of treatment to people older than 70 because of the potential for transformation to leukemia. Baby aspirin Some Trade Names
ECOTRIN
ASPERGUM
has been proven to decrease the risk of blood clots."

here is a link to the full article:

http://www.merck.com/mmhe/sec14/ch178/ch178b.html

SO IF YOU ARE NOW DOING YOUR OWN PHLEBOTOMIES AT HOME I SUGGEST THAT YOU STOP THIS PRACTICE AND SEEK PROFESSIONAL MEDICAL ASSISTANCE IN GETTING YOUR HEMATOCRIT IN ORDER.

I will never know for sure if this is what helped to bring on my blood clot, and the cause of Bapper's will never be known either but it certainly does raise some questions. I never knew that I was putting myself at risk of clots by taking out blood. I always thought I was doing something to prevent a clot since I was going to thin down the blood.

 

[Newman]

Why do they call Aspergum "Baby Aspirin"?

I thought that ever since Reyes syndrome was discovered, giving Aspirin to Babies & toddlers was a no go...

(I think parents generally give their kids "Childrens Tylenol" when they need a mild pain killer)

 

[iprimate]

I read the Merck article and it is consistent with what (at least two recent) Hematology textbooks contain on the topic of Polycythemia Vera and its treatment. Yes, you are correct phlebotomy does increase the risk of thrombotic events:

A randomized study [106,160] comparing phlebotomy alone with treatment with 32P [radioactive phosphorus] and with chlorambucil indicated that the life span of patients treated only with phlebotomy is better than that of patients treated with chlorambucil and no worse than the life span of those given 32P. Early in their course patients undergoing phlebotomy suffered more thrombotic episodes, but this was balanced by a lower incidence of leukemia late in their course. Surprisingly, there was no correlation between the level of the platelet count and the development of thrombotic complications. Apparently many patients can be well controlled by phlebotomy alone during much or all of their course, and the role of myelosuppressive therapy in the treatment of polycythemia vera has sometimes been questioned.161 It has been suggested that patients under the age of 50 who have no prior history of thrombosis might be treated with phlebotomy alone.[162]
(Chapter 61 Beutler et al, Williams Hematology6th edition 2000)

Risk factors for thrombosis include age, the use of phlebotomies, the rate of phlebotomies, and a prior history of thrombosis. Platelet counts have not been definitively linked to an increased risk of thrombosis.[1]

However, increased platelet count does not appear to be the cause of the increased thrombotic events.

Phlebotomy remains an effective and common treatment for polycythemia vera for "low-risk" patients
[2]:

Low-risk patients are those less than 60 years old who have had no thrombosis, no cardiovascular risk factors, and whose platelets are < 1,500 x 10(9)/L. These patients can be managed with phlebotomy alone or phlebotomy and low-dose aspirin.[1]

Phlebotomy is often combined with low-dose aspirin to offset (degree?) the increased risk of thrombosis, but at this stage I am unsure whether AAS users meet the category of "low-risk" patients.

As I see it if you are phlebotomising yourself to reduce the risk of thrombosis then it makes sense if -- and only if -- the addition of aspirin is sufficient to reduce the net risk of thrombosis to a level below your pre-phlebotomy risk of thrombosis. Some hypothetical numbers may help to make this point clearer.

Risk of thrombosis from AAS use: +5%
Risk of thrombosis from phlebotomy: +1%
Risk of thrombosis from aspirin use: -2%
Net risk of thrombosis: 4%

So if the use of aspirin entirely offsets the risk from the phlebotomy then you would be better off just taking the aspirin and not phlebotomising.

 

[maldorf]

I read the Merck article and it is consistent with what (at least two recent) Hematology textbooks contain on the topic of Polycythemia Vera and its treatment. Yes, you are correct phlebotomy does increase the risk of thrombotic events:





However, increased platelet count does not appear to be the cause of the increased thrombotic events.

Phlebotomy remains an effective and common treatment for polycythemia vera for "low-risk" patients
[2]:



Phlebotomy is often combined with low-dose aspirin to offset (degree?) the increased risk of thrombosis, but at this stage I am unsure whether AAS users meet the category of "low-risk" patients.

As I see it if you are phlebotomising yourself to reduce the risk of thrombosis then it makes sense if -- and only if -- the addition of aspirin is sufficient to reduce the net risk of thrombosis to a level below your pre-phlebotomy risk of thrombosis. Some hypothetical numbers may help to make this point clearer.

Risk of thrombosis from AAS use: +5%
Risk of thrombosis from phlebotomy: +1%
Risk of thrombosis from aspirin use: -2%
Net risk of thrombosis: 4%

So if the use of aspirin entirely offsets the risk from the phlebotomy then you would be better off just taking the aspirin and not phlebotomising.

Good info for sure. At the time I was taking an adult aspirin/day. For me it wasnt enough to stop my blood from clotting. I now take just the baby aspririn as my hematologist informed me that it provides just as much protection. My cardiologist also told me that aspirin counteracts one of the bp meds I was taking, and so a lower dose is better. I think it was my ace inhibitor that was affected, but its been awhile and I am not sure on that one. I am also now on coumadin, warfarin, to keep down any future clots. Once your heart is as weak as mine you run a greater risk of clots, and this combined with my past makes me likely to have another. I wont live through another blood clot.

 

[thebrick]

SO IF YOU ARE NOW DOING YOUR OWN PHLEBOTOMIES AT HOME I SUGGEST THAT YOU STOP THIS PRACTICE AND SEEK PROFESSIONAL MEDICAL ASSISTANCE IN GETTING YOUR HEMATOCRIT IN ORDER.

I have no idea how someone self administering this procedure at home would know what their final hematocrit levels are without the proper equipment. When I give double red platelets, its a LOT of packed red cells and very little fluid! Get professionals to do this! Don't guess at these numbers!

 

[bellicose]

Good info for sure. At the time I was taking an adult aspirin/day. For me it wasnt enough to stop my blood from clotting. I now take just the baby aspririn as my hematologist informed me that it provides just as much protection. My cardiologist also told me that aspirin counteracts one of the bp meds I was taking, and so a lower dose is better. I think it was my ace inhibitor that was affected, but its been awhile and I am not sure on that one. I am also now on coumadin, warfarin, to keep down any future clots. Once your heart is as weak as mine you run a greater risk of clots, and this combined with my past makes me likely to have another. I wont live through another blood clot.

It only makes sense that phlebotomy increases platelets. IV sticks aren't sterile procedures so some bacteria will get in and your body will respond by increasing its natural defense against infection....platelets!!!.

A little education for maldorf

there are 2 ways that typicall someone has a heart attack. The first is the most common and that is when a piece of plaque(that most of us have) breaks off in your coronary arteries(blood vessels in your heart). You body responds by sending platelets there to "plug the hole." The platelets do their job and aggregrate effectively and close or near close blood flow through the vessel. Aspirin works to prevent the platelets from being as "sticky" so they dont aggregate so aggresively.
The 2nd less common is a thrombosis travels to your coronary arteries from somewhere else in your body and plugs up the artery. A thrombosis can be caused from a crappy IV stick attempt or from not holding adequate pressure after an IV stick. It can also be caused from a host of other things including inactivity, long flights, poor circulation, etc.

You didn't have a "blood clot" You had a myocardial infarction. What caused it is almost impossible to find out.

The heart is incredible in design, it will sense restricted blood flow and create new vessels to bypass the clogged ones. This is why old people can survive multiple heart attacks but young guns often die from the first. The old guys have many different circulation patterns built over years of the heart compenating whereas young guys have only main vessels and a clot or thrombis can take them out quickly.


Anyone who is doing their own blood draw is a retard, you can have it done professionally for free and if your hemocrit isn't too high you can even help save somone's life.

 

[para]

Bapper was not doing this at home IIRC, he had a nurse doing it. What is the difference between that and giving a pint of blood at the red cross?

 

[GoneForever]

Mal, werent you taking more than a pint? Think that had to do with it?

 

[Press]

great post, thanx Maldorf!

 

[maldorf]

I have no idea how someone self administering this procedure at home would know what their final hematocrit levels are without the proper equipment. When I give double red platelets, its a LOT of packed red cells and very little fluid! Get professionals to do this! Don't guess at these numbers!

Yes. I am sure most guys doing it at home do not have a meter. When I did it, and I only did it 2x, I had a hemoglobin meter at home with test strips. I was able to track my own. I would test it about 3x per week. I did it before I did the draw, 3 days after, and then at the end of the week. I checked it MWF all of the time to make sure it wouldnt rise. That sucker was rising constantly. It only took about 3 or 4 weeks to get to a dangerous level again, and then its time to draw more. even when you are checking your levels, you are playing with fire since there are so many other things that can go wrong. After reading this research about how it can actually raise your chances of clots, I would not tell anyone do try this on their own.
What I should have done is get off the sauce like my docs told me. INstead I refused and tried to take care of it my own way. STUPID idea. When your bone marrow is overproducing rbcs like this, its a sign that something is really wrong. Just taking out the blood is only treating the symptom, and not the cause. Other things start going wrong then too and you open up a bad can of worms.
Im not on HRT and the doc has had to decrease my test dosage down from 150mg/wk to 100 mg/wk because my hematocrit climbed from 51 up to 56 in 2 months time.

 

[Press]

maldorf you never talk about how things are going in the gym now adays or if you have been able to progress at all in size being natural now. in other words hows shit going

 

[maldorf]

maldorf you never talk about how things are going in the gym now adays or if you have been able to progress at all in size being natural now. in other words hows shit going

I have a power rack, bench, pulldown/row machine, dumbells, and olympic plates in the basement. I just workout down there now. I havent been back to the gym since my heart attack, which I suffered there btw. Nobody there knows what happend to me, I just dissapeared. the night of the attack I quietly walked out of the gym and didnt say a word. They all knew me too since I was there so much. They all used to joke about how I must have a bed in the locker room. Anyhow, I do not really feel like going back there since it will remind me too much of what I used to have and how much I have lost. I decided to start fresh and just lift at home.
I am about the same bodyweight as I was when I had the heart attack, 225. BEfore the attack I was really lean, about 8% bf or so. Now I am probably more than 2x that. I figure I have lost about 25 lbs of muscle. Cant say how much of that is due to being off the steroids since i cannot push the weights I used to. If I go too heavy I get dizzy and nausea sets in. The very symptoms I had when I had my heart attack and arrythmia. I know for certain now that if I go all out I could kill myself literally. So it is impossible for me to maintain anywhere near what I used to have. For instance, I used to squat 455 lbs for about 12 reps and now I am doing 295 for 12 reps. I do not really dare to go much heavier than that.

 

[iprimate]

I have no idea how someone self administering this procedure at home would know what their final hematocrit levels are without the proper equipment. When I give double red platelets, its a LOT of packed red cells and very little fluid! Get professionals to do this! Don't guess at these numbers!

Regardless of whether you are autophleobotomising or getting a professional phlebotomy their is an increased risked of thrombosis. The polycytemic patients in the randomised study I referenced were all receiving phlebotomy from medical staff.

 

[iprimate]

Bapper was not doing this at home IIRC, he had a nurse doing it. What is the difference between that and giving a pint of blood at the red cross?

With respect to the increased risk of thrombosis: nothing.

 

[iprimate]

Sorry bellicose but your post is a both confused and confusing.

It only makes sense that phlebotomy increases platelets. IV sticks aren't sterile procedures so some bacteria will get in and your body will respond by increasing its natural defense against infection....platelets!!!.

The above is wrong.

Firstly, IV sticks are for all practical purposes are sterile procedures but further, and more importantly, megakaryopoiesis is inhibited after acute viral or bacterial infection. Platelets have an important role to play in the immune system but their production is not stimulated by infection but rather by inflammation.[1]

Secondly -- and most compellingly -- study I referenced found that the increased risk of thrombosis from phlebotomy had a weak relationship to platelet count. Phlebotomy produces an increased risk of thrombosis via some other -- as yet unknown -- mechanism.

A little education for maldorf

there are 2 ways that typicall someone has a heart attack. The first is the most common and that is when a piece of plaque(that most of us have) breaks off in your coronary arteries(blood vessels in your heart). You body responds by sending platelets there to "plug the hole." The platelets do their job and aggregrate effectively and close or near close blood flow through the vessel. Aspirin works to prevent the platelets from being as "sticky" so they dont aggregate so aggresively.

Coronary heart disease due to atherosclerosis is the commonest cause of heart disease in the West. It accounts for about 70% of cases of heart failure. You appear to be alluding to vulnerable plaques and their role in coronary occlusion. A special type of athersclerotic plaque is implicated in myocardial infarction (MI) -- termed vulnerable plaque -- and we don't all have this sorts of plaque. We all have arterial plaques but not all plaques are vulnerable. Vulnerable plaque is distinguished by (a) a lipid rich core (also containing macrophages and microcalcifications); (b) a thin collagen rich fibrous cap; and (c) inflammation within the plaque. These vulnerable plaques are vulnerable to rupture (hence the name) and when they rupture, thrombosis follows (due to platelet aggregation) on the ruptured plaque and this leads to the arterial obstruction which can lead lead to MI. MI and thrombosis are not mutually exclusive as you imply but rather quite often mutually inclusive. MI happens most often as a consequence of atherothrombosis. So maldorf is correct in saying he had a thrombus i.e. blood clot.

The 2nd less common is a thrombosis travels to your coronary arteries from somewhere else in your body and plugs up the artery.

You are confusing a thrombus with an embolism. A thrombus is a clot which is attached at its point of formation. An embolism is blood clot that detaches from its point of formation and travels to another site via the circulatory system to cause an occlusion.

A thrombosis can be caused from a crappy IV stick attempt or from not holding adequate pressure after an IV stick. It can also be caused from a host of other things including inactivity, long flights, poor circulation, etc.

These can cause an embolism or a thrombus.

You didn't have a "blood clot" You had a myocardial infarction. What caused it is almost impossible to find out.

Yes he did have a blood clot. The most common mechanism by which myocardial infarction occurs is atherothrombosis i.e. thrombosis superimposed upon a ruptured plaque leading to luminal obstruction.

The heart is incredible in design, it will sense restricted blood flow and create new vessels to bypass the clogged ones. This is why old people can survive multiple heart attacks but young guns often die from the first. The old guys have many different circulation patterns built over years of the heart compenating whereas young guys have only main vessels and a clot or thrombis can take them out quickly.

You are comparing apples with oranges. Young guns die most often from cardiomyopathy cause by left ventricular hypertrophy (see my posts on the topic).

Anyone who is doing their own blood draw is a retard, you can have it done professionally for free and if your hemocrit isn't too high you can even help save somone's life.

Who perform it isn't really the issue. The concern that maldorf has correctly identified is that phlebotomy increases the risk of thrombosis.

 

[Press]

I have a power rack, bench, pulldown/row machine, dumbells, and olympic plates in the basement. I just workout down there now. I havent been back to the gym since my heart attack, which I suffered there btw. Nobody there knows what happend to me, I just dissapeared. the night of the attack I quietly walked out of the gym and didnt say a word. They all knew me too since I was there so much. They all used to joke about how I must have a bed in the locker room. Anyhow, I do not really feel like going back there since it will remind me too much of what I used to have and how much I have lost. I decided to start fresh and just lift at home.
I am about the same bodyweight as I was when I had the heart attack, 225. BEfore the attack I was really lean, about 8% bf or so. Now I am probably more than 2x that. I figure I have lost about 25 lbs of muscle. Cant say how much of that is due to being off the steroids since i cannot push the weights I used to. If I go too heavy I get dizzy and nausea sets in. The very symptoms I had when I had my heart attack and arrythmia. I know for certain now that if I go all out I could kill myself literally. So it is impossible for me to maintain anywhere near what I used to have. For instance, I used to squat 455 lbs for about 12 reps and now I am doing 295 for 12 reps. I do not really dare to go much heavier than that.

do you get dizzy from say doing hi reps but keeping the weight low? say do 250 squats but do like 20-30 reps. this may help keep you lean and add some muscle. i take it ur diet has probably changed alot as well. ima shoot ya a pm.

 

[maldorf]

It only makes sense that phlebotomy increases platelets. IV sticks aren't sterile procedures so some bacteria will get in and your body will respond by increasing its natural defense against infection....platelets!!!.

A little education for maldorf

there are 2 ways that typicall someone has a heart attack. The first is the most common and that is when a piece of plaque(that most of us have) breaks off in your coronary arteries(blood vessels in your heart). You body responds by sending platelets there to "plug the hole." The platelets do their job and aggregrate effectively and close or near close blood flow through the vessel. Aspirin works to prevent the platelets from being as "sticky" so they dont aggregate so aggresively.
The 2nd less common is a thrombosis travels to your coronary arteries from somewhere else in your body and plugs up the artery. A thrombosis can be caused from a crappy IV stick attempt or from not holding adequate pressure after an IV stick. It can also be caused from a host of other things including inactivity, long flights, poor circulation, etc.

You didn't have a "blood clot" You had a myocardial infarction. What caused it is almost impossible to find out.

The heart is incredible in design, it will sense restricted blood flow and create new vessels to bypass the clogged ones. This is why old people can survive multiple heart attacks but young guns often die from the first. The old guys have many different circulation patterns built over years of the heart compenating whereas young guys have only main vessels and a clot or thrombis can take them out quickly.


Anyone who is doing their own blood draw is a retard, you can have it done professionally for free and if your hemocrit isn't too high you can even help save somone's life.

I am aware of everytihng you said, but thanks for the education!
I did have a blood clot in my right coronary artery. I watched them remove it with the suction device. I watched it on the screen as was asking questions the whole time. All of my arteries were wide open, including the one that they sucked the blood clot out of. In fact, he wanted to put in a stent as they customarily do but they didnt have a stent large enough for my artery. No narrowing whatsoever. I had no symtoms of occlusion until that night when i was squating heavy. Somehow, and yeah we will never know why, a blood clot formed in that artery. Could have been a tiny piece of plaque that broke off, who knows. If it was plaque it couldnt have been too large considering how my angiogram turned out.
So for you to come on here and say I didnt have a blood clot is simply conceited and ridiculous.

 

[maldorf]

Mal, werent you taking more than a pint? Think that had to do with it?

NO, i was doing about 500 ml, and 1 pint = 473 ml.

 

[maldorf]

Bapper was not doing this at home IIRC, he had a nurse doing it. What is the difference between that and giving a pint of blood at the red cross?

Certainly much better having a nurse do it thats for sure. The thing is, I believe when you see a hematologist you are having blood tests done regularly to monitor conditions inside your body. It seems that taking blood on a regular basis like this can cause unseen complications. Now I was never trying to blame this on my heart attack or Bapper's problem, but was suggesting that its not a good idea to do without a hematologist's experience. I was certainly being very foolish doing it myself, even with that hemoglobin monitor. I know others do it too and I am hoping to convince them to seek medical help and stop doing it on their own. Most docs I speak to about it wont even do it, they refer you to a hemo.

 

[maldorf]

It only makes sense that phlebotomy increases platelets. IV sticks aren't sterile procedures so some bacteria will get in and your body will respond by increasing its natural defense against infection....platelets!!!.

A little education for maldorf

there are 2 ways that typicall someone has a heart attack. The first is the most common and that is when a piece of plaque(that most of us have) breaks off in your coronary arteries(blood vessels in your heart). You body responds by sending platelets there to "plug the hole." The platelets do their job and aggregrate effectively and close or near close blood flow through the vessel. Aspirin works to prevent the platelets from being as "sticky" so they dont aggregate so aggresively.
The 2nd less common is a thrombosis travels to your coronary arteries from somewhere else in your body and plugs up the artery. A thrombosis can be caused from a crappy IV stick attempt or from not holding adequate pressure after an IV stick. It can also be caused from a host of other things including inactivity, long flights, poor circulation, etc.

You didn't have a "blood clot" You had a myocardial infarction. What caused it is almost impossible to find out.

The heart is incredible in design, it will sense restricted blood flow and create new vessels to bypass the clogged ones. This is why old people can survive multiple heart attacks but young guns often die from the first. The old guys have many different circulation patterns built over years of the heart compenating whereas young guys have only main vessels and a clot or thrombis can take them out quickly.


Anyone who is doing their own blood draw is a retard, you can have it done professionally for free and if your hemocrit isn't too high you can even help save somone's life.

BTW, once the clot was removed the cardiologist that took it out looked it over and by sight could see no plaque.I think it was sent to a pathologist whom confirmed this. I never heard any different It was all blood. I saw it with my own eyes. Hell I moved it around in the sample cup. My arteries really didnt show any narrowing. It might have been one of those tiny vulnerable plaques i suppose. I know my ldl was always quite low, much lower than average but my hdl was rock bottom. My hdl at time of heart attack was 14.