¡Help! (Another) Anemia Q (Hgb = 8.1)

[Idyllic]

My Hgb was 10.1 when I finished the Incivek last month (13 April 2012) and I thought I was dying. It was like walking in quick sand and my driving was dangerous. The labs I had drawn on Friday (11 May 2012) indicated my Hgb is 8.1.  The thing is I feel (basically) kind of normal.

Yesterday I mowed a half an acre of grass with the push mower, did three load of clothes and made a fairly decent dinner. The day before I went on a three mile hike with my dogs. These are all just regular chores but I could have never done those things last month at this time.  The only thing I noticed that is different is that my legs and arms get really sore. Like lactic acidosis when you work out on the weights after not having done so for a while.

The PA from my doctor's office called a little while ago and she advised me to reduce my Riba to 800 (from 1000) and to expect a delivery of Procrit within the next few days. Is this extreme? Isn't it supposed to be one or the other? I've read lots of other posts and realize there is no real standard as to when to intervene with hemolytic anemia but I was wondering if I should do either since I feel OK. Also from what I have gathered, apparently it isn't dangerous to walk around with slightly lower Hgb levels.

I'm glad the Procit is approved, covered and all lined up but I am only on week 19/48 and I would like to hold off on weekly doses if I can.  Believe me, if I felt the way I did last month at this time it would be different.  I figure if I do nothing my Hgb level will continue to decline but how about if I just do the dose reduction? I am interested in people's opinions and/or experiences about this.

I have an open appointment if I would like to discuss this in greater detail with the PA however I'd like to avoid it if we can just agree over the phone about the 200 mg dose reduction.
Thanks,
Konyha

[Dee1956]

Hey there, thinking of you.  I know what you mean, I thought that I would feel the same as I did when I treated the first time.  Boy was I wrong.
I am praying for you
Dee

[Idyllic]

I am far from any kind of Super woman I assure you!! I think it is because the drop probably happened gradually over about a month. I am guessing since I haven't had labs in between. Don't know about the Procrit. For some reason I honestly never thought I would end up having to take it so other than posts on here I have never really read about it.

The other hassle is that we are going abroad an May 30 to June 11 and I really did not want to have to hassle with keeping Interferon cool on a long distance flight with a six hour wait ^and^ worrying about the Procrit.

I agreed to the trip last year sometime before I realized just how much Incivek would change the whole treatment dynamic. I thought I would feel the way I did when I just took the Peg & the Riba. Boy was I mistaken...

[Idyllic]

Greeting and thanks for asking. Yes, I lowered my Riba to 600 last night. My husband kind of nagged me about it.  *sigh*

[Dee1956]

WOW!  Your platelets are great!  Mine were in the 70's by the time I was where you are now.  You really are doing great

[Dee1956]

Hey there, you are some kind of super woman, mowing the lawn?
Anywhoo, I am amazed at how you are feeling.  When I dropped from 14.8 to 9.7 I could hardly move.  So...maybe it is how your body adapts and how slow it goes down.  I don't know.  Please be careful and please rest.  We want to know you for a very long time
You are doing a great job.
Dee

[Bovary73]

Have you reduced to 600 mg? What are the strategies for your low hgb?
I hope you feel ok and that there's nothing to worry about..

[Idyllic]

I read the WIKI on Polychromasia, Elliptocytes, & Schistocytes and it doesn't look like anything to freak out over. It just defines characteristics of red blood cells such as colour, shape, and fragmentation.

[Idyllic]

Yay! Hgb is 8.9 not 8.1  

I have never seen the analysis under the RBC so I am reading about it. Hopefully it is nothing I need worry about. It is the comment underneath that says Polychromasia present  Elliptocytes present  Few schistocytes)


CBC
WBC 2.4L (4.0 – 10.5)
RBC   2.52L (3.8 – 5.10)
Polychromasia present
Elliptocytes present
Few schistocytes

Hgb 8.9L (11.5 – 15.0)

Hematocrit 28.2L (34 – 44.0)
MCV   112H (80 – 98)
MCH   35.3H (27 – 34)
MCHC 31.6L
RDW 17.1H (11.7 – 15)
Platelets 266 (140 – 415)
Neutrophils 38L (40 – 74)
Lymphs 52 (14 – 46)
Monocytes 10 (4 – 13)
Eos 0
Basos 0
Neutrophils (Absolute) 0.9L (1.8 – 7.8)
Lymps (Absolute) 1.2 (0.7 4.5)
Monocytes (Absolute) 0.2 (0.1 – 1.0)
Eos 0.0
Baso 0.0
Immature Granulocytes 0
Immature Grans (Abs) 0.00
Hemotology Comments Note: Verified by microscpoc examination

HCV RT-PCR, Quant (Non-Graph)
Hepatitis C Quantitation HCV Not Detected IU/mL
HCV log10
Unable to calculate result since non-numeric result obtained for component test

TSH 1.160 uIU/mL

[Bovary73]

On the 23rd of April my hgb was 9.6. I felt like crap and was suprised that it was that "high". One week later, on the 30 of April my hgb was at 7.3. I was more suprised because I actually felt better than the week before...my doc's explanation: if you f.ex. drink water right before you take the test, it affects the results.

[Idyllic]

Thanks, I know both you and Laura had a rough time with your Hgb levels and I was seriously hoping to avoid Procrit this early in the game. I'm still worried about not being UND at week 24. I just want to make it to that point so far.


On the other hand, one good thing about weekly labs is that I can sneak and check the HCV RNA box on the slips. That way I will know if I am still UND  more often rather than this once a month krap.

[Idyllic]

17.66 as in Hypo. I PM's my thyroid levels for the past three labs. There is only one thyroid panel.
Thanks!!

[BoceprevirGal]

I think you should probably take it a bit more easy, until you retest.  HGB at 8 can be hard on the heart, so better to play it safe.
   My HGB was at 9.3 two weeks ago, and I feel it has slipped some more, since then (havent had a blood test since then) and my legs do hurt and feel weak, when I walk up hill now. But I'm also cranky and cant get a deep brethe in, and you sound pretty cheery.
    Sounds like you did the sensible thing, by reducing tonight. You could see how your HGB count is, after a week reduction, (if the original 8.1 turns out to be accurate) and if that works, stick with that, instead of the Procrit.
   I am noticing the Procrit is only making me feel better for three days now, so I think you are being smart, in weighing in about the Procrit.

[nygirl7]

K

I'm tired never on at night so pardon spelling. Did you mean tsh of .17 or 17, way big difference there. Check and pm me.

Btw glad to know your name finally. I always call you Dyli In my head. Its a compliment lol.

Deb

[2mlbb]

Best of thoughts and prayers coming to you. Hang in there....

[Idyllic]

Thanks everyone for responding. My doctor's clinic has a Labcorp inside it (affiliated with it??) and if I show up before 8:30 am they can have my CBC by 2:00. They redid my thyroid labs when my TSH was 17 point something. My second TSH was higher so I hope this isn't a bad omen!!

I went ahead and reduced my evening dose just in case. . . .
K

[Ironpony]

Oh hunny I hope it is just an error like hrspwrguy! Willbb is right about the gradual drop though...it is harder to notice. I felt closer to death than I had ever felt at 8.1....but mone dropped from 10 to 8.1 in just about 8 days. so that was not gradual at all!

Either way, do take care and do what you need to for yourself. I wish you the best and will be thinking of you!

:)Laura

[hrsepwrguy]

I didn't feel any different through the whole thing, I thought for sure I would know if I dropped to 8.9 by being able to feel it as well, I sure felt the original drop to the 11's, I was reduced from 1000 to 400 mg's riba for 5 days

[Idyllic]

I was thinking that as well since I am just too asymptomatic and I don't think I would be if my level was really that low.


**I just listened to the message again and the dose reduction would be to 600 rather than 800.

[hrsepwrguy]

Yes it did happen to me a couple of weeks ago, at wk 30 was 11.9, wk 35 was 8.9, was reduced for 5 days and retested showed 11.9, was determined it was a lab error and put back on full riba, have been bouncing around in the 11's ever since (weekly cbc's)

[uncledudeness]

i believe the standard procedure is to reduce riba first and monitor the HGB. when it falls below 10, the use of procrit is approved. that is how it went for me. i was in the mid 8's for a few months and my riba was at 800. i was up to 3 shots of procrit a week. i think that was the reason why my hgb stabilized. when it hit 7 (8 or 9 months into treatment), i had to go straight to the hospital and get 3 pints. i think the problem with low hemoglobin is the increased risk of heart attack or stroke...not good. i had my cbc's done weekly, which i'm sure you must be doing too. good luck....

[dontworry_behappy1]

I sent you a PM

[can-do-man]

Might want to have them redo the CBC, from what you said it just might be an error.... That just happened to another member here a few weeks ago... Good luck