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How long before cytopenia improves post therapy
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How long before cytopenia improves post therapy

I finished my triple (48 week) therapy today and was found to still be undetectable! Great news but in the moment I'm concerned: I'm always anemic and thrombocytopenic as a result of cirrhosis but my ANC and Hemoglobin have been affected by the therapy too. My labs reveal an ANC (absolute neutrophil count) of 1.0 and my Hemoglobin is 10.6, platelets are 67 but most of that is related to the cirrhosis. Have any of you guys watched your lab values post therapy? I'm hoping for improvement in my ANC (I've got young kids and an active life so would prefer to remain infection-free)) with a little perking up of my hgb and platelets. Thanks. d
Tags: ANC
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446474_tn?1404424777
Congratulation on finishing treatment!!! 48 weeks is a long haul. That must be a very good feeling.

It will take time for your blood levels to return to pre-treatment levels.
Being cirrhotic will also impact what are "normal" levels for you. But pre-treatment levels should give you a good idea of the levels your future labs will return to over time.

Hemoglobin = 10.6
Anemia is defined as a hemoglobin level < 10 g/dL. While not technically anemia, you may feel better as your levels rise over time as your bone marrow will produce new RBCs. How high your hemoglobin levels will go would only be limited only by them be sequestered in your enlarged spleen if that was the case before.

ANC: There is no relationship between ANC and infections.
Mild neutropenia (1000 ≤ ANC < 1500) — minimal risk of infection.
But neutropenia during HCV treatment has never been shown to increase risk of infection during treatment. This has been shown in many studies. Many transplant centers including the one I am list at prescribes Cipro during HCV treatment in cirrhotics as cirrhotics are prone to infections anyway. So you have nothing to worry about as far as getting a virus from your children or leading an active lifestyle. To prevent infections, all cirrhotics should you should be keeping up on all vaccinations that become available to the public such as flu shots. Cirrhotics have a high priority when it comes to getting flu shots so even if there is a shortage of vaccine we should be able to get the vaccine.
Having cirrhosis makes you more prone to viral, bacterial and fungal infections (again depending on how advanced your cirrhosis is) rather than your mild neutropenia. Remember to take common sense precautions by washing your hands regularly and if possible avoiding persons with infectious diseases. I regular spend a lot of time at my transplant center and recently was infected with tuberculosis. Luckily it is latent and I have no symptoms. But I am treating it for 4 months with a drug can be toxic to the liver and can cause liver failure in healthy adults. So far my liver is handling it. But having decompensated cirrhosis and liver cancer is enough for me without a serious bacterial infection.

Platelet count is the number of platelets in your blood. Platelets are used by the body to clot blood. That is all they do. Having 67,000 is plenty of platelets for blood clotting. Only when platelet counts fall below 25,000 is there any reason for concern due to not being able to stop bleeding and if platelets are too few cirrhotics can spontaneously bleed under the skin. Your platelet count has no affect on how you feel physically. If a person has 300,000 or 70,000 platelets there is no way of knowing except by having a blood test.

I hope the drugs clear your system soon and you start to feel better. At the very least your liver disease may stop progressing if your portal hypertension is not too advanced. Then let's hope the your healthy hepatocytes will be able to heal themselves.

Best of luck to you!
Great job getting through 48 weeks having cirrhosis. A major accomplishment.

Hector

5 Comments Post a Comment
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446474_tn?1404424777
Congratulation on finishing treatment!!! 48 weeks is a long haul. That must be a very good feeling.

It will take time for your blood levels to return to pre-treatment levels.
Being cirrhotic will also impact what are "normal" levels for you. But pre-treatment levels should give you a good idea of the levels your future labs will return to over time.

Hemoglobin = 10.6
Anemia is defined as a hemoglobin level < 10 g/dL. While not technically anemia, you may feel better as your levels rise over time as your bone marrow will produce new RBCs. How high your hemoglobin levels will go would only be limited only by them be sequestered in your enlarged spleen if that was the case before.

ANC: There is no relationship between ANC and infections.
Mild neutropenia (1000 ≤ ANC < 1500) — minimal risk of infection.
But neutropenia during HCV treatment has never been shown to increase risk of infection during treatment. This has been shown in many studies. Many transplant centers including the one I am list at prescribes Cipro during HCV treatment in cirrhotics as cirrhotics are prone to infections anyway. So you have nothing to worry about as far as getting a virus from your children or leading an active lifestyle. To prevent infections, all cirrhotics should you should be keeping up on all vaccinations that become available to the public such as flu shots. Cirrhotics have a high priority when it comes to getting flu shots so even if there is a shortage of vaccine we should be able to get the vaccine.
Having cirrhosis makes you more prone to viral, bacterial and fungal infections (again depending on how advanced your cirrhosis is) rather than your mild neutropenia. Remember to take common sense precautions by washing your hands regularly and if possible avoiding persons with infectious diseases. I regular spend a lot of time at my transplant center and recently was infected with tuberculosis. Luckily it is latent and I have no symptoms. But I am treating it for 4 months with a drug can be toxic to the liver and can cause liver failure in healthy adults. So far my liver is handling it. But having decompensated cirrhosis and liver cancer is enough for me without a serious bacterial infection.

Platelet count is the number of platelets in your blood. Platelets are used by the body to clot blood. That is all they do. Having 67,000 is plenty of platelets for blood clotting. Only when platelet counts fall below 25,000 is there any reason for concern due to not being able to stop bleeding and if platelets are too few cirrhotics can spontaneously bleed under the skin. Your platelet count has no affect on how you feel physically. If a person has 300,000 or 70,000 platelets there is no way of knowing except by having a blood test.

I hope the drugs clear your system soon and you start to feel better. At the very least your liver disease may stop progressing if your portal hypertension is not too advanced. Then let's hope the your healthy hepatocytes will be able to heal themselves.

Best of luck to you!
Great job getting through 48 weeks having cirrhosis. A major accomplishment.

Hector

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317787_tn?1373214989
Congratulations Dennis, I am really happy for you.  I also have cirrhosis and understand the worry.
Hector has given really great information.  I can use that too.
My experience with the blood levels is that it can take a while for it to normalize.  You have just finished a hard tx and now your body has to recover from that.  It could be a month or it could be more.  I had blood work after the first month, it looked pretty good.  I also had the 3 month and am looking forward to the 6th
Again, I am so happy for you
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1116669_tn?1269146866
Thanks for the pertinent clarity Hector. Your facts and discrimination have been a great support in my efforts. And Dee: You're the best!..... For today my liver is no longer a picnic for the HCV. Happy weekend. d
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317787_tn?1373214989
I hope you are having a nice weekend as well.
I should have said that my AST and ALT are lower than they have been in 20 years so I am taking that as a good sign.
My best to you
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Avatar_f_tn
Congratulations on finishing 48 weeks of treatment.  You must be so relieved.  You've made it to UND at end of treatment, now onward to SVR!  Hooray.  I'm so happy for your yodennis.
Prayers for success.
Advocate1955
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