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Low WBC, RBC & Platelet, should I continue treatment?
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Low WBC, RBC & Platelet, should I continue treatment?

I was detected hep C last summer, seems I was infected by blood transmission when I was 3. I'm 23 and started my triple therapy Mar 29. So today is the first day of my 4th week treatment. Feel good during the treatment, less side effect. Only feel losing appetite and hard to finish 20g fat. I took my lab test this Wednesday.
I got the result today, it shows
HCV RNA, PCR Quant    not detec,
HCV Viral LOG               not detec.

But the WBC, RBC and platelet are abnormal, especially for my WBC.
WBC 2.1L    4.0-11.0K/UL
RBC  3.67L  3.80-5.10 M/UL
HEMOGLOBIN  10.8L   11.5-15.5 G/DL
HEMATOCRIT    33.4L  34.0~45.0%
PLATELET COUNT 99L   130-400 K/UL

Should I continue the pegasys injection tonight? I already contacted my nurse, but the phone call turned to voice mail. I read some articles, seems when having a low WBC you need stop the treatment. I'm just shock when I seen this, because I feel everything go through better than I thought before I start my treatment.

Sorry for my poor English, I hope I express everything clearly and offer enough information.

Really appreciate your reply.
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Avatar_m_tn
By all means do your shot tonight, your labs are fine........ Congrats on being Und.
40 Comments Post a Comment
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Avatar_m_tn
By all means do your shot tonight, your labs are fine........ Congrats on being Und.
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Avatar_m_tn
Should I continue the pegasys injection tonight?
------------------------------------------

Absolutely!
Everything your blood labs show is perfectely normal for someone undergoing HCV therapy and  nothing there shows anything of immediate concern

The WBC and HGB ..is usually somewhat less  than normal for someone doing tx,however yours actually look very good

The plats at 99 are somewhat low and would be monitored by a good treating physician ,however again..not anywhere near the level of immediate concern ( lower than 50 many doctors would take action ,however many have been know to continue tx. as low as in the 20's)

Good luck the rest of the way and welcome...

Will
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Avatar_f_tn
Thanks!!  
Your reply makes me feel better!!
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Avatar_m_tn

The above poster covered it all  while I typed...

Will
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Avatar_f_tn
Thank you Will.
From your number, I get kind of understand about the level I should pay attention to. I will keep tract with my plats.
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Avatar_m_tn
:)
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Avatar_m_tn
         your cbc is stable.   its low on platelets, hemo, and white cells, but does not look like anything to stop tx for
       btw,  congrats on being und at 4 weeks, thats huge.  keep on keeping on.  
                              barry

                  ps   always check with your dr
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Avatar_f_tn
Thank you for your reply.

Is there anything I can do about my platelets and others? Or just let my dr know?
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Avatar_f_tn
Just to let you know my platelets got down to 31 and my WBC was always below 2 and they continued tx. Enjoy your shot tonight :) and Congrats on UND wk 4

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Avatar_m_tn
Your platelets are fine at 99, nothing to worry about. As a matter of fact your levels show treatment is working quite well... A HGB at 10.8 on treatment is great also.........
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Avatar_f_tn
Thank you!!! I was terrified by my mom, she keep mentioned a long list of food that can improve WBC. But when I ask my dr, he said he would not recommend bc the Incivek may have conflict with these food.
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Avatar_m_tn
           hi kally,  i think you are doing very good on your therapy.  your tx dr  can lower your peg dose to 135 mcg if your wbc falls to 1.6... if your hemo falls below 10 your dr has options there also.  when my platelets fell below 75, my dr said "dont fall down".  yes, always let your dr know.  your rvr  is reason to stay on tx.  
                                        barry
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Avatar_f_tn
I think I probably worried to much. Bc I feel a little bit sleepy when I step in the 3rd week of the treatment. Not like the side effect said insomnia. My dr said it probably bc of anemia. So when I get my lab, it shows abnormal, I was shocked.
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Avatar_f_tn
"your tx dr  can lower your peg dose to 135 mcg if your wbc falls to 1.6.."

************

Why on earth would you recommend that?
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1840891_tn?1383280315
You can't do anything about any of those numbers. If they get severe enough your doctor might prescribe "rescue" meds that will help, or might suggest reducing the dosage of your ribavirin, but you are not currently near to those levels. Each doctor does things slightly differently, but to give you a better idea of the problem numbers, most do not worry about platelets unless they go below 50 (and then consider Rx Promacta or transfusion), most do not worry about HGB until it goes below 10, and some let it go as low as 8 before taking action (Rx of procrit injections or possibly transfusions), and most do not worry about low WBC unless the ANC drops below 0.5, and then consider dose reduction, Rx Neupogen injections, or stopping tx.

During tx my HGB dropped as low as  10.1, my ANC dropped as low as 0.6 and my platelets dropped as low as 0.51. My doctor ordered more frequent testing (weekly) each time something dropped near to the cutoff  line, but each time the numbers bounced back a little on their own without intervention. I completed 48 weeks of tx in Sept 2012, without any rescue meds or dose reductions, and am now SVR.

You can do it, just make sure you have frequent tests whenever the numbers drop very low, as not everyone has them bounce back on their own!
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Avatar_m_tn
"Bc I feel a little bit sleepy when I step in the 3rd week of the treatment. Not like the side effect said insomnia. My dr said it probably bc of anemia."

I agree with your doctor. Soon this will be all over and your well on your way to being cured...:)
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766573_tn?1365170066
You are in week four and you are UND that is fantastic news :)
On the other hand

Errr...wait a minute just to be clear you started treatment 29 March and you say "I took my lab test this Wednesday."
That means
Friday, March 29, 2013
To and including: Wednesday, April 17, 2013

is 20 days.

3/29 week - 4/5   week 1
4/12 week 2
4/19 week 3
4/26 week 4
___________________________

This is interesting because you are young and presumably in good health (??) and while I would take my shot of Peg I have to say to me at this stage if your dates are accurate these meds are really kicking in.

Can you tell us more about your health and whatever else might matter? I would do my shot as well but I am wondering about your Peg dose and how you are feeling. The reason I ask is because over the next few weeks your values may stablise, gradually drop or plummet.

When I was on Incivek one minute my Hgb was 10.1 and I felt fine and the week after the my Hgb was 8.1.
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766573_tn?1365170066



I agree with all that has been said. I would just keep having the lab tests when you are scheduled and be sure your viral load draws are scheduled on the right dates.

I am glad you are feeling well.
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Avatar_f_tn
Thank you for your numbers. These gives more conception about how low I can go. I think I have waste most of my time with my dr. Next time I should ask him how low he think I can go. :) Anyway, I feel good I'm UND and not very severe side effect. The only thing right now is finish the rest 8 weeks quickly and get rid of Incivek. The 20g fat make my stomach feels bad.
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Avatar_m_tn
              i dont recomend dose reduction at 1.6. when i reached that threshold, i was told by tx dr that protocol is dose reduction to 135 and to do cbcs weekly until cbc is stable.  i had 2 dose reductions to 135mcg of peg and i am und for 14 weeks post tx.  so   protocal

                                   barry
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766573_tn?1365170066
Yes this disease can be very time consuming with the lab visits and doctor appointments and the three times a day you take the Incivek (as well as the doses of Riba). It helps to be organized.

It is a good idea to ask the doctor how low certain values on your CBC can drop and what will he do when they do.


For your WBC the value that it helps to know is the one called Absolute Neutrophils. It might say Neutrophils (Absolute) abbreviated as ANC. That number is used as a gauge rather than the WBC.

So (basically) your Hgb, ANC and platelets are the values to keep an eye on.
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Avatar_f_tn
hahaaa~ No problem. Feel happy to share with you.

I think my health is in good condition. No smoking, drink little before detect hep C, since July 2012, I quit drinking. When I start the treatment feel less side effects. I think sometimes I feel hard to have 20g fat, bc I don't eat that much before I have the treatment. And I don't choose the right fat source. I feel I don't like peanut butter. Right now I'm having soup with 1 and a half tbs olive oil. Olive oil seems good for our health, :) and it can help lose weight. That's my motivation right now. My suggestion is start 20g fat food a little bit earlier than the treatment. Let our stomach have more time to adjust to new food diet. And choose the right fat source.  

But when I get my base lab test, the WBC and RBC shows close to the bottom line of the range. So that's why I'm very worried about the WBC.

About my does. I have peg 180mg, Riv 1000mg (600mg am,400mg pm), Incivek 2pills per time, 3 times per day( I believe it's 375,but I'm not sure, I will check after I'm back home)

I guess I'm UND so quick bc my viral loading is low. Bc my dr said my viral loading is low when last time I meet with him. If you are interesting I can share with you late after I'm back home.
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Avatar_f_tn
I find Neutrophils on my lab, it shows 12.5 11.0-15.0%. This one is normal, I only copied the abnormal date. So from this one it looks good right?
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Avatar_f_tn
I think there are other factors involved before dose reduction is considered.  Congrats on your post UND!

Kally...do you have a Neu # on your lab report?  The range should be around 2.0 - 7.0.  This will be your ANC # and that would determine if you need Neupogen or not.
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Avatar_f_tn
hey Juiles,

you mean  Neutrophils 12.5 11.0-15.0%, this one?
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Avatar_f_tn
WBC 2.1 Neu % = 12.5% Then your ANC would be .26.  I am surprised your Dr has not suggested Neupogen just to get all of those levels up.  I think I have seen some with that low of range.  It doesn't make you feel bad but can be dangerous if you were in a car accident or something major due to internal bleeding.  You should talk to him about this.  Do your gums bleed or is your urine red?
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Avatar_f_tn
Hey Jules,

Sometimes I have gums bleed, but it act the same as I'm not on treatment, so I don't take it into consideration. I will talk to my dr ASAP. So should I do the shot tonight?
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Avatar_f_tn
Jules,

I'm soooooo sorry. I copied the wrong line. The Neutrophils should be 57 40-74%
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Avatar_f_tn
If it were me...... I would take the shot.  I never reduced when my Dr's told me to but that is ME!  This is your decision...not mine.  If you do take it just take it easy and don't start up the chainsaw or anything like that :)
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Avatar_f_tn
Sorry, the Neutrophils should be 57 40-74%
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Avatar_f_tn
OK ok much better.  Your ANC level is 119.  Your in good shape!  It's low but they probably won't bring it up until <50 if not lower.  Enjoy your shot and take it easy over the weekend.  You will be fine
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Avatar_f_tn
Thank you!  I have learned a lot today. You guys are better doctor assistants!!
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Avatar_m_tn
         so that there is no confusion kally, your stable.  do your shot
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Avatar_f_tn
Yes! No confusion. Soooooooooo happy that I'm UND now! I would have a more positive attitude to fight the 20g fat! Thank you so much! Without you I think I will have depression for the 4th week. :)
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1815939_tn?1377995399
Just want to correct something that got posted (due to treatment induced brain fog, I am sure). Neutrophils have nothing to do with bleeding. I am sure Jules meant to say platelets when she was referring to the bleeding and infection when she was referring to absolute neutrophils.

When the Absolute Neutrophil Count gets low, there is a possibility of increased risk of infection. That is why the docs keep an eye on the absolute neutrophil count. If your count does get too low, your doctor can order Neupogen.



  
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Avatar_f_tn
Thanks pooh! You are correct. Brain fog ughhh
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Avatar_f_tn
Your insurance company will always tell you to stop treatment and or go to the hospital for every little thing. I have 1.6 WBC as of 5/10/13 and my doctor told me to hang in there so I am. I can only trust my doctor's advice. The internet is also full of information that can scare the daylights out of anyone on this treatment if you let it. I'm on my 24th week but I need to go 48. Keep the faith.
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1840891_tn?1383280315
This last post "The internet is also full of information that can scare the daylights out of anyone...." Is very true. You really need to filter your information. This forum is one if the best places to get info because it is very self-correcting. When someone posts incorrect info, whether from brainfog, typos, or old-fashioned ignorance, it is always corrected by another member within a day or less. After a pretty short time you will learn which posters are always reliable (or which ones think more like you do and thus make the most sensible explanations for you).
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Avatar_f_tn
Hello everyone,

I just get my new CBC lab results
it shows:
WBC  1.5
RBC   3.02
Hemo 9.1
Hema 28.0
Neutorphils 54%
Monocytes 3
Platelet      83

This lab is taken by the end of week 6. I'm just feel afraid that I need to take Neupogen later some time. I heard it has side effect as well and need lab test weekly. Have an appointment with my dc this Wednesday, he has no suggestion about my treatment plan last meeting, but I think I can take only 24 weeks bc I was UND at week 3.
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1815939_tn?1377995399
Several people on the forum have taken Neupogen and several have taken Procrit so they would know the side effects. Those helper drugs have helped many get through treatment and attain SVR. Hopefully you will also get through treatment and attain SVR. Keep us posted.

If you were UND at week 3 and do not have cirrhosis or were not a null or partial responder in the past, then you will probably do 24 weeks.
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