Low ABS Neutrophils

[IwillBeatHCV]

Hello everyone. I just got a call from the study nurse/coordinator and have been advised that my 20th week blood tests shows my ABS Neutrophils have dropped to 580. Will have to lower my peg-interferon (pegasus) dose to 135 until I get my insurance company to approve Neupogen or until my neutrophils go back up. But I am afraid this will affect my SVR. Everything was going fine with Tx but deep inside I knew it was too good to be true. I did research and found out that if the neutophils drop below 500, I will be succeptable to getting a serious infection at any time. Oh well, I guess i just joined the 20% of people on tx that come down with neutropenia. Is anyone familiar with Neupogen and experience with its side affects? And how long does it take for it to raise the WBC counts?
Thank you all in advance and hope everything is going well for everyone.

[dutch_boy]

I wish I could tell you some magic "trick" to get your hemoglobin levels up.....but I have not found that "trick" yet.  When I referred to getting my hemo levels up I was specifically saying by using Procrit.....although my doctors are amazed how I'm functioning at a 7.3 hemoglobin level and they keep asking me what I'm doing!  The only things I can tell you I am committed to is walking everyday about 1.5 miles, taking folic acid (1 mg. day prescription), vitamin B-12, and a multi-vitamin.  I don't know if any of these things help "raise" your hemo levels but I do know that when I stopped walking for about 2 weeks my levels dropped very low.  My doctors tell me keep doing what I'm doing as I'm functioning fairly well with such low levels.  I hope this helps a little...this whole blood issue can be mysterious and confusing at best.....
Scott

[IwillBeatHCV]

Thanks everyone for your responses and as always, I get lots of valuable information from all of you. I guess there's no need for me to worry too much now that I know that the ABS eutrophils fluctuate so much.

Snook_man:  I am currently on a study at the University of Miami--is that where you're going also??

tonyz: they want to lower my interferon dose to 135 from 180. I will ask why not 165...

dutch_boy: My HGB is at 11.6...

Is there anything we can do besides drugs to raise our WBC?? Just curious...

[GoofyDad]

Dutchboy: You speak of getting your hgb back up. Do you take proactive measures, like exercise or diet that you find to help?


Pirate: Thanks. That's interesting. I Learned something new today. Now instead of one number to fret, I've got a bevy to parse and dwell on.

[Pirategold]

I went to this link:

http://hepatitis.va.gov/vahep?page=tp02-02-01-90

and discovered that NUE, LYM, MONO, EOS and BASO make up the subdivisions of WBC and they each fight different bad guys:  NUE fight serious infections -- they play a key role in inflammation, allergic reactions, pus formation, and in destroying bacteria and parasites; LYM fight viruses; MONO fight foreign bacteria; ESO are similar to NUE; and BASO are similar to NUE.

They are arranged in our CBC reports in order of greatest to smallest number found in the WBC.  

If you add together all of the numbers, the total equals your WBC.

Pirategold

[dutch_boy]

Like others have experienced, my ANC has fluxuated between about 580-800 for many months.  Everytime I get close to 580 the doctors start raising the red flag and threaten dose reduction as well as neupogen...but in every case my ANC bounces back just in time.  My hemotologist tells me that my ANC is related to my blood levels as a whole....including my hemoglobin levels.  It was explained that when my hemoglobin levels drop very low (an ongoing problem through tx for me...topped out at 7.3 with 60,000 units of Procrit weekly) that I should expect my white levels  and neutrophils to also drop quite low as well. I used to see the white levels and the red levels as two distincly different blood systems not being effected by one another....but have learned now over time that they are in fact related to one another and one effects the other tremendously.  Although we do know that interferon knocks down the whites and the Riba knocks down the reds they are related.....when one gets knocked down by one drug it WILL EFFECT the other. The reason I bring this all up is I am curious how your hemoglobin is doing?  If your hemoglobin is not stable or at very low levels this will also effect your ANC. I am very well aware now after months of battling low Hemoglobin that when my hemo is at it's lowest so is my ANC....and when I get my hemoglobin up a little my ANC gets out of the danger zone as well.  Just a thought....I do however contradict myself here as I know people who have very low ANC levels with normal range hemoglobin levels.  Where do you stand with your hemoglobin?
In the meantime I hope you don't have to resort to getting the neupogen but if you do it does seem to work wonderfully and very quickly for most people.  Keep us posted and in the meantime I hope you stay well and that your ANC bounces upward on its' own like so many here have experienced.
Best to you, Scott

[snook_man]

I know that you are in Florida, and if I remember correctly, the South end. When you say nurse coordinator, I wonder if we do not see the same GI center even.
My nuetrophils bounced around, and hit a low of 600. Right when they where going to intervene, and began taking notice, the numbers rebounded back up to 800. When I finished at week 48, I was up to 900. My wbc's since week 12 stayed low though, never reaching higher than 1.8..
Ask for another CBC, to see if there is any fluctuations.. But definately put in the call and have the nupogeon waiting as a back up..
Good luck!!

[Tonyz]

During TX my ANC went down to 480 at one point, as stated in an above post, my team did not intervene with Neupogen till the ANC count was below 400. I was taken down to 165 MCC of pegasus for several weeks till my ANC went up and we then back to 180MCC.
This is an acceptibale practice. You might ask him if he will first try a dose 164 MCC first.


             God Bless


               TonyZ

[cougareyes]

Like Jim says ANC does bounce alot, and if you take your bloods within 72 hours of your shot it can possibly show a lower reading. As goofy and others have stated neupogen does work quickly.
I am not sure when your shot nite is but try and push through with your insurance. Although you are past the critical time in tx, the 1st 12-wks, I'd hate to see you have to lower your dosage.    Good Luck

[jmjm530]

I'll just add that ANC can bounce up and down irrespective of Neupogen. Mine has been as low as 680 during tx but fortunately keeps bouncing back. Currently it's in high 800's. Hopefully, yours will bounce back by itself by your next blood test.

-- Jim

[GoofyDad]

I had no ill affects from my first Neup shot. If anything I feel better, but I don't think that's the Neup.

I want to emphasize that I freaked a little reading on the internet about Neupenia. Then my nurse told me that their center does not have the same experience as they do in cancer centers. I was avoiding kids, & yogurt, lettuce, doing all kinds of strange stuff. Unnecessarily, I now believe.

At stage 3-4 (higher risk) and ANC 475 she gave me permission to wait a few days for another CBC before shooting the Neup. I had it in then fridge. Then news of my hip situation changed her attitude a bit.

I wouldn't suggest what you should do as far as medication, but if it were me I wouldn't freak too much about the ANC for now. That's just my personal take. I would push it through Insurance a fast as I could.

I hope it all works out well for you.

[nyhepc]

i'm taking neupogen. it works very quickly and keeps my counts up for 3 days, so i get two a week. i'm careful to have labs drawn on the 6th day and not the 7th. maybe fatigue is a side effect, feeling a little draggy but that may just be me waiting for the shoe to drop. i just restarted tx at peg 90 so am taking only 150mg of the neupogen at a time

[GoofyDad]

Look back over the last week or two. There are at least 2 good threads. One was friole, who narrowly dodged Nuepogen, and one was me. I used it on Tues and on Fri my ANC went to over 2K,  from 475 prior week. Cougareyes has alot of info.

My team lets ANC go down to 200-300 except in stage 4 patients where they intervene at 500-750. I got special consideration due to an artificial hip. I asked about special diatary restrictions and their response was that their patients don't get the exotic opportunistic infections that oncology patients get. Low level bronchial and respiratory problems are what they see in HVC patients. I took to washing my hands ALOT.

Someone was posting about heart murmers last week. I just remembered that my son had a heart murmer problenm as an infant, and they said difficult-to-treat infections were a possibility due to eddies in the blood flow through the heart. He's 100% resolved, but I thought I'd mention that for anyone interested.