Apollo 13 calling lab gurus...

Well, this weeks labs show much improvement in my whites. Last week my WBC was .58 and ANC .26, so the 3 shots of nuepogen did the trick. A lot of stuff now showing H and L. Can I get the lab gurus to help me interpret? Thanks.



7/10/08  
Protein, Total 6.5 6.0-8.4 g/dL  
Albumin 3.4 3.5-5.0 g/dL               L
Calcium 7.7 8.5-10.5 mg/dL           L
Bilirubin, Total 0.6 0.0-1.5 mg/dL  
Alkaline Phosphatase 94 40-150 U/L  
AST 41 7-40 U/L                          H
Glucose 100 65-100 mg/dL   H
BUN 10 10-25 mg/dL  
Creatinine 0.84 0.70-1.40 mg/dL  
Sodium 138 135-146 mmol/L  
Potassium 4.3 3.5-5.0 mmol/L  
Chloride 108 98-110 mmol/L  
WBC 2.97 4.0-11.0 k/uL               L
RBC 3.30 4.5-6.0 M/uL                 L
Hemoglobin 10.7 13.5-17.5 g/dL    L
Hematocrit 36.9 40-52 %              L
MCV 111.8 80-100 fL                   H
MCH 32.4 27-34 pG  
MCHC 29.0 32-36 g/dL                 L
  Repeated and verified
RDW-CV 18.9 11.7-15.0 %           H
Platelet Count 46 150-400 k/uL     L
MPV 11.5 7.3-11.1 fL                   H
Neut% 77.4 40-70 %                    H
Abs Neut 2.30 1.8-7.7 K/uL  
Lymph% 13.8 22-44 %                  L
Abs Lymph 0.41 1.0-4.0 k/uL         L
Mono% 7.1 0-7.0 %                      H
Abs Mono 0.21 0-0.8 K/uL  
Eosin% 1.7 0-4 %  
Abs Eosin 0.05 0-0.4 K/uL  
Baso% 0.0 0-1 %  
Abs Baso 0.00 0-0.2 K/uL  
CO2 24 23-32 mmol/L  
Anion Gap 6 0-15 mmol/L  
  
ALT 41 5-50 U/L  
-----------------------------------



"Houston, we have an early cutoff on engine 5..."

" Copy that 13, we don't know why the center engine cutout early... but we are going to go ahead and burn the other 4 a little longer to compensate..."

" Ok Houston, we copy" "

"Looks like we survived the glitch for this mission...."

[gauf]

more specifically:

Mono% 7.1 0-7.0 %                      H
MCV 111.8 80-100 fL                   H
MCHC 29.0 32-36 g/dL                 L

What is this?

[Marcia2202]

am no lab guru.... but am wishing you the best. You're in my prayers!

Marcia

[willing]

no guru here, but methinks you're out of the woods and dodged a close one.
Re the H/Ls see:
http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm

looks like volume of your  RBCs is on the large side and their mean HGB level is down, as one might expect from RBCs struggling with RBV saturation.  Also, one of your types of WBC, monocytes,  is a tad over-represented, maybe a sx of the neupogen doing its job.

[jmjm530]

FWIW my ANC dropped to .32 and then upped itself within two weeks to over 1 without Neupogen or dose reduction. ANC does has that tendency to bounce around a lot, and too many docs seem to pull the Neup trigger a bit too fast.  That said, the Neupogen was a reasonable call in your case, however you might discuss with your doctor monitoring your ANC once or twice a week without Neupogen to see if you really need to continue it.

[mremeet]

Yet another non-guru, but I think overall things look pretty good. Your HGB ain't bad at all, AST and ALT are alright, as I'm sure you already know they can elevated during treatment and everything is working fine (and they're hardly "elevated" anyway).  Neutrophils are acceptable, looks like the neupogen did its thing. I guess everyone's different, and ANC's do bounce around some, but once I hit my trough during the latter phase of my treatment, I was pretty consistently bouncing between 400-600 (i.e. 0.4-0.6), I wouldn't be so sure you would have rebounded so nicely without the neupogen, might want to keep it close by - especially considering you were unhorsed on one of your earlier treatments (your first I believe) by an infection of some type (if memory serves?). Again as I'm sure you already know, the neutrophils are important for fighting infections, so keeping them up instead of riding the wire is probably a good idea. Your glucose looks good, especially if that was a fasting draw. I believe you said you were diabetic or borderline diabetic? Anyway, it looks pretty good, especially if you've been eating the kind of garbage I ate when I was on treatment ;-) . Also do you happen to know what your cholesterol breakdown is? The only reason I ask is because there's a study that strongly correlates tx success with elevated pre-tx cholesterol levels, especially LDL cholesterol (the bad kind).

The other stuff I don't know much about. Obviously your platelets are low and that's important within the context of cirrhosis. What does your doctor say about them? Is he concerned and does he plan on drawing the line somewhere with them? Hopefully all the peculiarities in the lab work tea leaves that pertain to cirrhosis are ok. But overall based on what little I know, I think you're doing good. I think you're on the right track dude and you're gonna make it to the promised land this time. Halla-freakin-lieua brother! J/K, hang in there gauf.

[gauf]

It was a fasting draw except for a teaspoon of PB with riba (mmm-mmm goooood). I am currently living on the worst diet imaginable, mostly Arbys'. (gained 10 lbs since start of tox) Have no idea what my HDL/LDL might be. Doc suspected NASH and prediabetes a yr ago, but has never said another word about it. I never really ever see this guy, just the NP.  My platelets are holding for now so will stay on 1600 Riba until they start to tank. I am currently on 3 shots of neup a week and 1 shot procrit. I am holding up pretty well.

[mikesimon]

I believe that the interferon impacts the platelet count significantly more than ribavirin does. Mike

[CockSparrow]

Monocyte
Leukocyte (white blood cell) that functions in the ingestion of bacteria and other foreign particles. Monocytes make up 5-10% of the total white blood cell count.

Diagnostic use
A monocyte count is part of a complete blood count and is expressed either as a ratio of monocytes to the total number of white blood cells counted, or by absolute numbers. Both may be useful in determining or refuting a possible diagnosis. Monocytosis is the state of excess monocytes in the peripheral blood. It may be indicative of various disease states.
Examples of processes that can increase a monocyte count include:
• chronic inflammation
• stress response
• hyperadrenocorticism
• immune-mediated disease
• pyogranulomatous disease
• necrosis
• red cell regeneration

Mean corpuscular volume (MCV)
MCV is the index most often used. It measures the average volume of a red blood cell by dividing the hematocrit by the RBC. The MCV categorizes red blood cells by size. Cells of normal size are called normocytic, smaller cells are microcytic, and larger cells are macrocytic. These size categories are used to classify anemias. Normocytic anemias have normal-sized cells and a normal MCV; microcytic anemias have small cells and a decreased MCV; and macrocytic anemias have large cells and an increased MCV. Under a microscope, stained red blood cells with a high MCV appear larger than cells with a normal or low MCV.

Mean corpuscular hemoglobin concentration (MCHC)
The MCHC measures the average concentration of hemoglobin in a red blood cell. This index is calculated by dividing the hemoglobin by the hematocrit. The MCHC categorizes red blood cells according to their concentration of hemoglobin. Cells with a normal concentration of hemoglobin are called normochromic; cells with a lower than normal concentration are called hypochromic. Because there is a physical limit to the amount of hemoglobin that can fit in a cell, there is no hyperchromic category.
Just as MCV relates to the size of the cells, MCHC relates to the color of the cells. Hemoglobin contains iron, which gives blood its characteristic red color. When examined under a microscope, normal red blood cells that contain a normal amount of hemoglobin stain pinkish red with a paler area in the center. These normochromic cells have a normal MCHC. Cells with too little hemoglobin are lighter in color with a larger pale area in the center. These hypochromic cells have a low MCHC. Anemias are categorized as hypochromic or normochromic according to the MCHC index.

In other words Gauf you have hemolytic anemia, Probably caused by taking around 1600mg Riba. But hey what would I know, I am no Dr.

Apart from haemolytic anemia and some neutropenia your bloods looks really good.
Your platelets are holding up really well considering.

How do they compare to the 2x Tx that failed.

All the Best
CS

[gauf]

You are the resident lab guru now dude. I don't remenber specific labwork from the other 2 tox's, but my WBC did get to .1 when they pulled the plug on tox 1. Tox 2 had me on nuep and procrit throughout, same dose I am currently on, so nothing really unexpected. What can be done to battle haemolytic anemia?

[FlGuy]

see:

http://www.labtestsonline.org/

It has a lot of information about medical tests.  No so different that the type of definitions provided to you by CS.  It's easy to naviagte.

[CockSparrow]

Gauf - What can be done to battle haemolytic anemia?

You are already doing it. Taking B12 and Folic Acid can help with creating new red cells.
Ok they are for Pernicious Anemia but if you are low in them it wont help.

as you know EPO (Procrit) also helps create new red cells.

But if you really want to improve your haemolytic anemia lower your Riba dose.
Actually dont do that just yet.

As FLGuy said Labtestsonline is good, and so is wikipedia for blood test explanations.

CS

[gauf]

Gratitude.

[Trish77]

gauf, I'm taking B12 and folic acid at the moment...I'd read that it doesn't actually help with this kind of anemia and put that to my doc and he said mostly right and that it helps in 15% of cases give or take.  Well, for the cost of it and some odds vs no odds, I'm taking it.  I take 250mg of B12 a day and 5mg of folic acid.  I just started taking 300mg of  "ferrous gluconate" - elemental iron - a day as the doc said my iron is depleted and the procrit (eprex for me) will not work as well with low iron so .. doing that as well.  Take a look at your iron stores...perhaps a consideration while you're doing procrit, I dunno...just tossing that out there for you.

However, your numbers are on a bit of an upswing this week...for a guy your hgb is on the low side and you're dealing with that.  Nice to see your whites improve a bit.

Happy space travel...and continuing to cheer you on from the observation gallery.

Trish

[FoieGras]

MCV is Mean Corpuscular Volume, or how big the average red cell is. By big I mean volume: the red cell is basically just a bag of hemoglobin. The MCV answers the question, how big is the bag?

These measurements are made by squirting a thin layer of blood past a microscope/electrical thingy which can recognize the red cell and tell how big it is. Average millions of measurements and you get the Mean Corpuscular Volume.

With hemolytic anemia, the red cell factory in the bone marrow goes into overtime, and produces lots and lots of things call reticulocytes, big, fat cells  which are released into the blood and become red cells. Reticulocyte levels increase in the blood. The machine cannot differentiate btw retics and rbcs, so the bigger retics increase the measured red cell volume.

MCV is low in iron deficiency anemia and some hemoglobin diseases like sickle cell or thalassemia. Usually when it's high the explanation lies in the increased reticulocyte count as described above.

RDW is Red cell Distribution of Widths. Plot #red cells on y axis, vs red cell width on x axis, and you get a distribution, same idea as a bell curve. If high, tells you that the curve is shifted to the right or there are two or more populations of red cells, small old cells and big young ones.



No bad news there, gauf - keep goin!

[evangelin]

Thanks for that wonderful explanation.  You are very good at breaking things down and I think you'd make a great teacher. Knowing it is one thing but being able to deliver that info in a form that can be well grasped by others is a gift in itself.  
Ev

[FoieGras]

Thank you evangelin!

*****Blush****