Help with understanding blood test?

I received my first post treatment blood test results in the mail today and I don't know whether to be discouraged or not.  I live in a very rural area.  My doctor is a GP, there are no specialists within hundreds of miles.  My doctor ordered the medicine and I have not seen or heard from him since.  Upon Bill1954's advice, I did call for a blood test schedule and was told by the nurse to come right in.  I couldn't get off work, so I went in the next week, my second week of treatment.  I called yesterday to ask them to send my prescriptions to a company my insurance company deals with as at the local pharmacy my copay is $606.50 for interferon and $50 for ribaviron per month.  I paid that one month and now will be receiving the drugs through the mail for $69 for 90 days worth.  While I had the nurse on the phone I asked again about the blood test schedule.  She said to come in a week from the first one.  It's confusing because I want and need a schedule so I can plan.  I run a one person post office and can't just leave whenever.  I must plan.  Well, sorry about all the unnecessary detail, but I'm overwhelmed with this tx and I'm hoping for some help understanding if I'm wasting my time.

I'm genotype 2b, my pretreatment viral load was 5,490,000.  This last blood test did not include a viral load.  I don't understand the rest of it so I'm hoping if I list what they have flagged high or low someone can tell me something.

4/27/10 test:                                          6/11/10 test:

ALT    107                                             ALT     36
AST    74                                              AST    39
RCB    5.35                                           RCB    5.54
WBC   8.4                                             WBC   5.1
HGB  16.7                                             HGB    17.1
LYM%  37                                             LYM%  56
MONO %  8                                           MONO % 13
EOS %   3                                             EOS %  1
GRAN# 4.3                                             GRAN# 1.5

I hope someone can help.  I'm out of sorts today.  It's the first time I've really felt the interferon interfering with my mood.  And it's bad.  If HGB is hemoglobin, mine is not dropping enough to make me think this is working.  Maybe I should stop?  Please help me understand.

Carol                                              

[nygirl7]

Even though 800 is standard for a  geno2  not knowing how close you are to an actual weight based ribavirin level I would wonder about that. Like Bill said while it CAN be indicative when hemo drops of a good riba serum level it doesn't have to be - but with yours going up that is quite odd.

You need to talk to the doctor and make sure that he will schedule a
week 4 PCR, week 12 PCR, week 24 PCR and then an EOT PCR at least. Then after end of treatment at least a month after and then 3 months then 6 then 12.

Also as he is a GP he might not realize to add in a TSH level test at about week 24 to check how your thyroid is doing. It's tough that you are treating with a GP but my doc a GI had really no real knowledge of hepc treatment (he thought he did). I lived in NY and figured he must be pretty good but uh no. I learned everything I could in here then showed him why I should have PCRs, why I should have this why I should have that......at first he was really annoyed with me but by the end of treatment he admitted I had taught him a lot about the disease and in fact knew more than he did and it would help his future patients. I hope it has. Anyway though if your doctor will at least listen to you (dont tell him you learned stuff on the net tell him just the words "support group" or they tend to hve their heads spin around like you are insane........it will help you a lot.

Again do you know how close the 800 is to being weight based and will he check your iron and also about the PCRs those are the questions I'd ask the most.

PS Liver enzymes leveling out is a good thing!!!!!!!!!!!

[carol411]

Actually, my HGB is going up.  That can't be promising, can it?

[banarep]

your alt/ast are your liver numbers and they are in the normal range.  that is good.

your hgb is your hemoglobin or red blood count and going up is good.  the rest you can find on line by putting the the letters.

when was your last viral load test?  you should have another one.

are these post treatment or during treatment?

[carol411]

I meant my first blood test post starting treatment.  I'm not communicating well today.  I've been treating for three weeks.  One of the theories I've read here is that a hemoglobin drop means that you are getting enough ribaviron.  Mine is going up.  Is that OK?  

[GreatBird]

You need to have a quantitative PCR run in order to determine what your viral load is. None of the tests you have listed do that.

Another thing to keep an eye on are your platelets and I don't see a number for them.

Your liver enzymes normalizing is a very good sign. Your HGB has gone up and it could be a little high to start out with depending on how old you are. I have no idea what that means but it makes me wonder if anyone checked your serum iron and all that stuff before you started. There are people on the boards who know more about that than me and hopefully one of them will speak up and explain how it works with treatment and HCV.

[GreatBird]

P.S. Your profile has your age and it seems that according to that your HGB is high to start out with. Worth looking into.

[Bill1954]

Hi Carol,

For starters, nothing appears to be holding really bad news; that’s the good news :o). When we first start treatment like you have, we want to make sure that things like red cells (hemoglobin), white cells (absolute neutrofils), and platelets aren’t crashing; and yours don’t appear to be doing so. Although I didn’t see a result for platelets (PLTS?); were they included somewhere in those results? At least we know you’re not going to get sick from this treatment immediately.

There is some evidence that a reduction in hemoglobin might be predictive of ribavirin concentration, and from there, treatment success, but you can discuss this with the doctor; when is your next appointment? How much ribavirin are you taking; how many pills per day? It is rather curios that it remains so high.

On a personal note, while my hemoglobin dropped substantially over time, I never became anemic enough to require rescue drugs; and I eventually achieved SVR. I’d still ask the doctor about it; ask if you’re dose is weight-based or if it’s flat based.

You’ll hopefully have a four week viral load test; this will be more predictive of success than any of these biochemical tests anyway.

Good luck to you—

Bill

[carol411]

Thank you all!  It seems I was overreacting.  I will, when I get an appointment, ask about weight based dosage.  Mine is the standard for type 2, 800 mg a day.  

Bill and GreatBird my PTL was 294 pre-tx and is now 157.  But it is not flagged as being high or low.  

[newleaf09]

There's often a bit of drama, like white blood cell counts falling, at the beginning.  You started out with such high counts, that yours are still safe even though they've fallen a good bit.  My HGB went up a little in the first few weeks and then fell steadily after that.  I imagine yours will fall soon.  Do get a 4 week viral load count, as it can predict how well you are responding to the meds. Blood counts are generally monitored fairly often in the beginning, since that's when drops are so dramatic, then less often as your body gets used to the presence of the meds.  Look up the AASLD HCV treatment guidelines online.  Those guidelines from liver specialists are the ones most frequently followed by less specialized doctors and will detail how often bloodcounts, thyroid hormone levels  and viral load should be monitored.  I think that a 4 week viral load PCR is recommended for genotype 2 patients, but if not, request it anyway.

[nygirl7]

Even though 800 is standard for a  geno2  not knowing how close you are to an actual weight based ribavirin level I would wonder about that. Like Bill said while it CAN be indicative when hemo drops of a good riba serum level it doesn't have to be - but with yours going up that is quite odd.

You need to talk to the doctor and make sure that he will schedule a
week 4 PCR, week 12 PCR, week 24 PCR and then an EOT PCR at least. Then after end of treatment at least a month after and then 3 months then 6 then 12.

Also as he is a GP he might not realize to add in a TSH level test at about week 24 to check how your thyroid is doing. It's tough that you are treating with a GP but my doc a GI had really no real knowledge of hepc treatment (he thought he did). I lived in NY and figured he must be pretty good but uh no. I learned everything I could in here then showed him why I should have PCRs, why I should have this why I should have that......at first he was really annoyed with me but by the end of treatment he admitted I had taught him a lot about the disease and in fact knew more than he did and it would help his future patients. I hope it has. Anyway though if your doctor will at least listen to you (dont tell him you learned stuff on the net tell him just the words "support group" or they tend to hve their heads spin around like you are insane........it will help you a lot.

Again do you know how close the 800 is to being weight based and will he check your iron and also about the PCRs those are the questions I'd ask the most.

PS Liver enzymes leveling out is a good thing!!!!!!!!!!!

[carol411]

All of you who responded to my rambling concerns have a special place in my heart.  I thank you.  

Newleaf09, I have looked up the info you suggested and will study it later.  But in a quick look through I got curious of the effect of smoking on hemoglobin so I looked it up.  I have always thought of cigarettes as my medication of choice for keeping an even keel.  Yes, there are side effects, as there are in any medicine the doctor prescribes.  Now I am forced to rethink my position.  It turns out all smokers have increased levels of hemoglobin and may in spite of the levels be anemic.  Since beginning tx my behavior can only be described as chain smoking.  I know now how stupid I am being.  I have some hard thinking to do.  Can I quit and treat at the same time???  I don't know, but I will discuss it with my doctor.

I cannot thank you all enough.  Your support is a lifeline.

Carol