Methotrexate and low white cell blood counts

[lizziecee]

I am concerned that my Gp's nurse rang today to say, after my normal monthly blood tests last week for mtx, and said ,your white cells are low and I have to see him ASAP. Seeing my Gp next week,first appt I can get on 23 March.Guess it is not a serious problem.  Some 35 yrs on steroids, but some 6 yrs on mtx oral meds 25 mgs weekly, and some 2 yrs on subcup injections. 12.mgs weekly. I was also dx with bc ductal cancer in 2003 - treated with FEC chemo and 25 rads.Had dexamethasone for 4 months daily whilst on chemo.Am a bit of a loss to understand how I could cope with FEC chemo with no neutropenian and now have it some 3 yrs later. Am very concerned as to where I go to now. Steroids are a no go as I got steroid induced psychosis just after being dx with bc. I think my low blood counts are due to mtx, but after 35 yrs of this disease, mtx has been my life saver. Where do I go from here?
Thank you Dr.Kevin for any insight or help.

[Kevin Pho, MD]

Neutropenia is a known side effect of MTX.  If this is suspected, the medication would have to be stopped.

A bone marrow aspirate should be done as the next diagnostic step if other reasons are suspected.

Other tests can include ANA levels to look for collagen vascular disease, antineutrophil antibodies to look for immune neutropenia, immunoglobulins to evaluate for humoral immunity disorders, an HIV test and a vitamin B12 test.

These options can be discussed with your personal physician, or in conjunction with a hematologist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[lizziecee]

Many thanks for your timely response - much appreciated. I forgot to say I was px mtx for Crohn's but guess you figured it out!
This just gets weirder. My IBD Specialist nurse rang me this morning, quite concidentally,  to say my next month's mtx injections have been delivered by courier to my GP's office - I do them myself now.

I told her of the GP's receptionist's call yesterday and she brought up my last blood results on her computer. She said my white blood cells are normal, at 10, whatever that means, and went on to say my whole blood count was high. Said she would ring the GP to sort it out. Rang me back, confirmed the white cell count, and whole blood count, and advised me to go to the appt with the GP next week. I am utterly confused now. She said I should continue to take the mtx. We don't typically get copies of our blood work here, as folks in the US do, so I have no way of comparing previous results. I shall ask for a copy of the Mar 5th tests when I see him next week.  Guess all wil be revealed in time. It is very rare for my GP to call me in, which is why I was a tad alarmed.
Thanks again,
Liz.