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Avatar universal

Are these lab results normal for us with HBV?

These results have always been consistent with me and have been told by several doctors that it's due to the chronic HBV body always fighting, so I'm wondering if these are "normal" for us?

I have consistently low WBC this time of 3.2 (normal is 3.4-10.6) but sometimes it goes into the high 2's, high RBC this time 5.01 (normal 3.68-4.88), lower end of absolute neutrophil of  1.70 (normal is 1.40-6.60), lower end absolute lymphocytes of 1.08 (normal 1.00-3.40).  Platelets seem ok and always range between 220-250 (normal is 149-349) and albumin okay too.  

Started Viread 2 months ago.  Waiting on DNA but think it should be UND since DNA was low to begin with.  ALT went down from 34 two months ago to 27, and AST stayed the same both times at 30.  Don't know if a fluke or due to Viread.

1.  A BIG question of mine that probably Steff can answer is if I want to try Interferon later (if the US gets their ***** in gear and gets quant hbsag ever) does my constantly low WBC count and lower end of neutrophil count scratch this possibility off the table from the start (since I know INF lowers these anyway and with mine already low would INF knock it down so low I would have to go off INF)?

2.  Another question is regarding AFP.  My AFP tumor marker test has always been around 1.1-1.5, checked every 6 months or so.  This most recent blood test was the first time I've seen it go into the 2's (it was 2.2 but still in normal range).  Is this 2.2 abnormal for me since it's ALWAYS  been in the 1's or do I only worry about AFP if it goes into abnormal range?

3.  My last question, going back to the low WBC and lower neutrophil count....does this put me at a greater risk of getting other infections or not being able to fight off cancer per say since I know the WBC/neutrophil job is to go and attack and fight these things before it gets to be an issue?  I rarely get sick and usually have lots of energy, which to me doesn't make sense with the consistently low WBC.

4.  If the WBC/neutrophil count is low due to HBV will this resolve over time with taking the Viread?  Also, I've consistently had splenomegaly and mild portal hypertension.  Will these resolve and possibly "fix" the WBC/neutrophil count with long term Viread?  I also take 5,000 iu Vit D3 and waiting on the latest results from that still.
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Avatar universal
Thank you stef.  Below is what my neutrophil and platelet counts are.  I think platelet count has always been ok, but not sure if neutrophils are too low to consider peg down the road?  I think I would be bummed if so (but better to know now), because as of now this is what gives me hope for the future.

Abs Neut
1.70 x10(9)/L
Reference Range:1.40 x10(9)/L - 6.60 x10(9)/L

Platelet
225 x10(9)/L
Reference Range:149 x10(9)/L - 375 x10(9)/L
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Avatar universal
dont worry too much about wbc count, pegintf is stopped on low neutrophils and very low platelets

i had wbc less than 3 while on peg but no problems with neutro or plts, they never lowered my dose.i had terrible sides and no response when i stopped supplements like vit d3, gcmaf and others while response started back when on high dose d3, so like for other members some supplements maybe a must for peg to respond at its best
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Avatar universal
Probably within a month, maybe a bit shorter. I will keep some suplements during peginf too, those ones which I'm sure won't interact with peginf. My ALT is since half a year around the maximum normal value, sometimes below sometime a bit above 35-45 less or more.
How was your liver before peginf and how it's now after clearing ? Did fibroscan score improve ?
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Avatar universal
My WBC and neutrophils was pretty much in line while on ETV. While I was on ETV, I was on junk food, and pretty much living unhealthy, lots of sugar etc. But my body still respond by sero-converting to e-antigen negative. I did do astralagus, milk thistle, maitake and curcumim as well but not religiously. Also, probiotics powder because I have heard that 70 to 80% of your immune system lies in the gut.

Your diet are excellent. Garlic and ginger are both good for you in general.

Of course I do see that maybe I was one of the lucky ones to eradicate the virus at a very reduced dose of IFN. I was happy to see high ALT at the beginning when it jumped to over 100 to 180 within the first 4 shots.

This virus, although can be controlled with good diet, plays a psychologically mind barrier to your mental health, so good support is needed around you. This forum is as good as any.
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Avatar universal
Well done !! You are giving your body a very good chance.

When are you starting IFN? Here hoping you get a respond. High ALT would be an good indicator.
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Avatar universal
Do you know if your WBC/neutrophil count increased while on Entecavir?  I'm hoping the Viread will maybe help (I have mild splenomegaly and mild portal hypertension)?  I was taking milk thistle and Astragalus herbs (Astragalus has been studied to raise wbc) and then stopped 2 months ago when I started Viread (worried these may affect Viread).  While on herbs my WBC was still on the lower end around 4.0, but better than 3.2.  Should I go back on these herbs?  I recently started eating fresh garlic and ginger and have taken for a long time D3, selenium, K2, liquid multivitamin, eat lots of fruits and veggies daily, and coffee.  
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Avatar universal
I had similar routine now, D3, zinc, magnesium, selenium, good food with lot of antidoxants, cocoonut oil, nigela sativa and other stuff to prepare body before starting interferon. My viral load went down from 5600 to 600 in less than 3 months just on supplementation.
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Avatar universal
My WBC was at the low end at 4.0 and neutrophils at the low end at 2.3 just weeks before IFN treatment.

WBC was around 4.5 to 5.5 for the last few years while on Entecavir but gets low to 4.0 just before IFN.

Just on those viral suppression, I constantly changed my diet 6 months pre-IFN treatment by researching the net. So I started drinking watermelon juice, beets and carrot juice regularly, take coconut oil as an anti-viral, warm lemon water in the morning, take zinc, selenium and Vit D3 supplements, started eating dry shiitake mushroom for their anti-viral effects and drink jasmine green tea throughout the day.

I truly believe now that the immune starts in what you eat. Your body can make the virus to very low levels without treatment if you sero-convert to e-antigen negative (low viral replication). However, you still need something like IFN to fully eradicate the virus.

To this day, I still take extra virgin unrefined coconut oil with my coffee daily. Also coffee is good for your liver. Why it takes me so long to learn this, I don't know but its better to start than never. It's all up to you!!
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Avatar universal
No apologies needed, I greatly appreciate the help!  :)
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Avatar universal
Thank you and so awesome for you!!  Was your WBC and neutrophils on the low end before treatment?  That is my concern.  If Interferon is even still pretty much our only option I'm thinking years down the road, after I've been on Viread for at least a few years and hopefully after the US gets hbsag quant.  I was wondering if Interferon is off the table for me from the start, due to my constantly low WBC numbers?

So, there is more viral suppression to go, since it still says detected  (even though less than 20), right?  
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Avatar universal
My assumption is that your next appointment re: HBV DNA, it will be UND after more than a few months on TDF.

As with IFN treatment, any out of whack numbers will have the Dr stopping you completely or most likely reduced your dose to 135mcg or 90mcg.

Blood test are done every 2 injection early in the treatment and then every 4 weeks. You will be immune to seeing needle up your veins at this stage and might even swap to left arm.

My experience with IFN was that after my second injection, my nurse reduce my dose by half to 90mcg due to low neutrophils (0.6).

First 2 shots - 180mcg
3 to 12 shots - 90mcg (Viral Load UND after 12th shots)
13 to 32 shots - 135mcg
33 to 40 shots - 90mcg (after 36th or 37th shots, my HBsAg turned negative, developed surface antibodies of 55)

41 to 46 shots - 135mcg
47 and 48 shots - 90mcg

So even with the reduced dose, I cleared the HBV surface antigen. My surface antibodies has since climbed to 900.

Its good that you are taking 5,000iu of D3 daily as I was taking a lot pre IFN to try to boost my levels to at least 50ng/ml (I was deficient at 50 nmol for a very long time as I dont take Vit D3 supplements). It went up to 129 nmol after a few months. This, along with good diet, supplements and juicing should get you over the line.


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Avatar universal
Please accept my apology for my wrong assumption.It is purely my own confusion.

As for your AFP, I am not an expert. My general understanding is that the lower the cut-off value(the convention at the moment is, as you say, 20 ug/L), the higher the sensitivity, but lower the specificity, as a marker for HCC.. Personally, I would think 2.2 is very low and would not be concerned.

Regular monitoring for HCC is recommended for women over 50.

Hope I got it right.
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Avatar universal
Thanks Mike.  I'm guessing it's nothing for me to worry about then, although I will ask my doctor to make sure.
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Avatar universal
My AFP in 2007 was 3 and as of 2011 been always 4 so not sure if this is considered significant or just normal although still within range
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Avatar universal
Thanks Stephen.  I guess my user name was the reason you thought I may be pregnant, but I am definitely not pregnant (I have teenagers now!).  Should I worry that my AFP went up into the 2 range after good tracking for over 10 years (from the 1's) with not being pregnant?

Should I consider the <20 iu/ml but detected as good as it's going to get, or with more time on Viread should the results go even lower and actually report "undetected"?  Thanks again!
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Avatar universal
Pregnancy can affect your AFP level (as the fetus produces AFP), so discuss with your doctor and don't worry for nothing.

hbvdna may be detected but the test is not sensitive enough to give you an exact number, except to say it is less than 20 iu/ml(or whatever the limit of their assay).
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Avatar universal
Yeah, this kind of confused me, should it go even lower to UND or is their assay so sensitive will it detect any DNA and aways and report as detected but <20?  Ugh!

Any thoughts on the other blood work questions?  Thank you!
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Avatar universal
I always wondered too if hbv dna test can say for sure there's no virus or it can just say "there is less than 20 IU maybe even zero". Someone can give conslusive answer ?
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Avatar universal
Further help...

I received my HBV DNA back today after 2 months on Viread.  This is what it says...


HBV-DNA Quant
Detected IU/mL (Abnormal)
Date:Jun 18, 2015 09:09 a.m. MST  Reference Range:Undetected

Comment:HBV DNA level is <20 IU/mL (<1.30 log IU/mL). This assay cannot accurately quantify HBV DNA below this level. Result in log IU/mL is <1.3 The quantification range of this assay is 20 IU/mL to 170,000,000 IU/mL (1.30 log IU/mL to 8.23 log IU/mL). Testing was performed by the COBAS AmpliPrep/COBAS TaqMan HBV test, version 2.0 (Roche Molecular Systems, Inc.). Test Performed by: Mayo Clinic Laboratories - Rochester Superior Drive 200 First Street SW, Rochester, MN 55905

I thought less than 20 was considered UND, but it says detected but less than 20?  Should I consider this UND or with more time on Viread should it actually say "Undetected" as the reference range states (instead of Detected IU/mL (Abnormal)) ?  Thanks!
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