More A Patient’s View of Blood Tests and What They Mean for the Liver Transplant Candidate

Platelets are only about 20% of the diameter of red blood cells, and they are the most numerous cell of the blood. The normal platelet count is 150,000-350,000 per microliter of blood, but since platelets are so small, they make up just a tiny fraction of the blood volume. The principal function of platelets is to prevent bleeding. Platelets are produced in the bone marrow, the same as the red cells and most of the white blood cells. Platelets are produced from very large bone marrow cells called megakaryocytes. As megakaryocytes develop into giant cells, they undergo a process of fragmentation that results in the release of over 1,000 platelets per megakaryocyte. The dominant hormone controlling megakaryocyte development is thrombopoietin (often abbreviated as TPO), which comes from the liver. Low platelets happen to occur in people with chronic liver disease because the liver is damaged and scarred. The liver cannot produce enough of a substance called thrombopoietin, which is important in creating platelets.

Platelets are not only the smallest blood cell, they are the lightest. Therefore they are pushed out from the center of flowing blood to the wall of the blood vessel. There they roll along the surface of the vessel wall, which is lined by cells called endothelium. The endothelium is a very special surface, like Teflon, that prevents anything from sticking to it. However when there is an injury or cut, and the endothelial layer is broken, the tough fibers that surround a blood vessel are exposed to the liquid flowing blood. It is the platelets that react first to injury. The tough fibers surrounding the vessel wall, like an envelop, attract platelets like a magnet, stimulate the shape change that is shown in the pictures above, and platelets then clump onto these fibers, providing the initial seal to prevent bleeding, the leak of red blood cells and plasma through the vessel injury.

Having low platelets can get in the way of your taking medicines and having diagnostic procedures, such as a liver biopsy. Why? Because your blood does not have enough platelets and you are at risk for bleeding. The liver transplant candidate most times also bruises easily.

Red blood cells are the most numerous blood cell, about 5,000,000 per microliter. Red blood cells make up about 40% of our total blood volume, a measure called the hematocrit. Their color is caused by hemoglobin, which accounts for nearly all of the red cell volume. Hemoglobin is the critical protein that transports oxygen from our lungs to the tissues. Red cells are normally shaped as round, biconcave discs. With microscopic examination, they look like a red or orange tire with a thin, almost transparent center. Their function is to carry oxygen throughout the body to organs and the like. They are produced in the bone marrow.