Aa
My Hemoglobin is down to 9.3
Down from 10.3 2 weeks ago. How does that rate please?
New blood draw for Monday. If my hemoglobin stays above 9 to stay with riba reduction to 800mg. If it drops below 9 they will order the procrit which will all takes time. Some progress I guess was made here...
New blood draw for Monday. If my hemoglobin stays above 9 to stay with riba reduction to 800mg. If it drops below 9 they will order the procrit which will all takes time. Some progress I guess was made here...
Thank you for your response. My response went to frijole on the recent update. Too bad to get such crappy care.....
Thank you for the post. Yes, I have to stay with my insured provider for my hep c care. I AM VERY UNCOMFORTABLE WITH THEM. I just called the hepc docs office to see if they will order my blood draws weekly instead of monthly as the clearly reduced my riba for a reason. More to be revealed. Thanks so much for your help. towards me.
I agree wholeheartedly with Frijole. And believe me Procrit saved my course of treatment, with it I barely stayed in the 10.5 range and I was on 40,000 every five days. I would have had to quit tx without it. I had no problem with it and my doctor knew to keep my under 12 so it was no sweat.
I also wanted to add that my hemoglobin is 9.3 this week and I am on week 42. It first dropped into the 9s at week 9 and I could hardly function. It has gotten up to the 10s with procrit but now procrit only keeps me in the 9s. I guess I have adjusted to it, but all that means is I go to work and go home and lay on the couch. It is not a comfortable quality of life. Take care of this.
frijole
frijole
Hep c doc said it is quite the mess to get hooked into the procrit aspect of recovery
Whoa - that sounds like a stupid statement from your doctor. Do you have to stay where you are? Is it possible to let a hemotologist do the blooed monitoring?
I will contradict what working dog said. HGB of 9.3 is bad and to have it already at week 8 is not a good sign. The riba reduction should help some but you may need to do both - procrit and riba reduction. Working dog also said some people were not impacted by HGB in the 7s and 8s -- well, I consider that bs too. HGB in the 9s is debilitating. Anyone who is working out with HGB in the 7s and 8s is foolish because the heart can only pump so much.
http://web2.iadfw.net/uthman/unanemia/unanemia_outline.html
"....As the blood continues to thin out, less and less oxygen-laden hemoglobin is presented to the tissues per unit time. The result is oxygen starvation at the cellular level. But the body, not ready to give up yet, has several tricks up its sleeve:
Increased cardiac output. The volume of blood the heart pumps through itself per unit time is called the cardiac output. In the normal resting state, the heart pumps about 5 liters of blood every minute, abbreviated 5 L/min. This means that the heart is easily capable of pumping the body's total blood volume through its chambers in one minute. Actually it is capable of much more than that. When there is a greater demand for oxygen, as during vigorous exercise, the heart can increase its output manyfold, to as much as 30 L/min. It does this by increasing not only the number of beats per minute (the heart rate) but also the volume of blood pumped with each stroke (the stroke volume). .... In anemia, the cardiac output increases, and that allows more hemoglobin to be exposed to the peripheral tissues, making up for the decreased hemoglobin concentration. Accordingly, the heart rate increases, which gives us one of the cardinal clinical manifestations of anemia, tachycardia, or fast heart rate.
The heart does not act alone to increase the cardiac output. It has to have cooperation from the peripheral tissues and the blood itself. If nothing changes in the body but the heart rate and stroke volume, the heart will be trying to pump blood faster into a fixed, unchanging bed of blood vessels. This is like trying to squeeze thick dishwasher detergent gel out of its container by pushing harder. The only way to make the gel dribble out faster is to increase the pressure. Analogously, in the body, to push more blood through an ungiving vascular bed would require a higher blood pressure. Higher blood pressure would cause the heart to work harder, because it would have to pump against a high pressure head, just like a muscle has to work harder to lift a heavier weight. Clearly this is not in the best interest of the body. Fortunately, the blood pressure is kept from going up by two factors. The first is the viscosity of anemic blood. Viscosity is the quality of a fluid which tends to cause it to resist being propelled through a tube or opening. Thin, anemic blood is less viscous than normal blood and can be pushed through the vascular bed with less pressure. The second factor is the blood vessels themselves. The wall of each small artery or vein contains one or more layers of muscle capable of responding to nerve signals by contracting. This causes the vessel to close down to a smaller caliber and be more resistant to the flow of blood. Other nerve impulses cause the muscles to relax, letting the vessels expand to a wider caliber and allowing more blood to flow with less resistance. In the anemic patient, the brain sends signals to the muscles around the small vessels telling them to relax and open up. The result is less impediment to the flow of blood. Therefore, because of less peripheral vessel resistance and thinnet, less viscous blood, the cardiac output can rise without causing the blood pressure to go up. "
frijole
Whoa - that sounds like a stupid statement from your doctor. Do you have to stay where you are? Is it possible to let a hemotologist do the blooed monitoring?
I will contradict what working dog said. HGB of 9.3 is bad and to have it already at week 8 is not a good sign. The riba reduction should help some but you may need to do both - procrit and riba reduction. Working dog also said some people were not impacted by HGB in the 7s and 8s -- well, I consider that bs too. HGB in the 9s is debilitating. Anyone who is working out with HGB in the 7s and 8s is foolish because the heart can only pump so much.
http://web2.iadfw.net/uthman/unanemia/unanemia_outline.html
"....As the blood continues to thin out, less and less oxygen-laden hemoglobin is presented to the tissues per unit time. The result is oxygen starvation at the cellular level. But the body, not ready to give up yet, has several tricks up its sleeve:
Increased cardiac output. The volume of blood the heart pumps through itself per unit time is called the cardiac output. In the normal resting state, the heart pumps about 5 liters of blood every minute, abbreviated 5 L/min. This means that the heart is easily capable of pumping the body's total blood volume through its chambers in one minute. Actually it is capable of much more than that. When there is a greater demand for oxygen, as during vigorous exercise, the heart can increase its output manyfold, to as much as 30 L/min. It does this by increasing not only the number of beats per minute (the heart rate) but also the volume of blood pumped with each stroke (the stroke volume). .... In anemia, the cardiac output increases, and that allows more hemoglobin to be exposed to the peripheral tissues, making up for the decreased hemoglobin concentration. Accordingly, the heart rate increases, which gives us one of the cardinal clinical manifestations of anemia, tachycardia, or fast heart rate.
The heart does not act alone to increase the cardiac output. It has to have cooperation from the peripheral tissues and the blood itself. If nothing changes in the body but the heart rate and stroke volume, the heart will be trying to pump blood faster into a fixed, unchanging bed of blood vessels. This is like trying to squeeze thick dishwasher detergent gel out of its container by pushing harder. The only way to make the gel dribble out faster is to increase the pressure. Analogously, in the body, to push more blood through an ungiving vascular bed would require a higher blood pressure. Higher blood pressure would cause the heart to work harder, because it would have to pump against a high pressure head, just like a muscle has to work harder to lift a heavier weight. Clearly this is not in the best interest of the body. Fortunately, the blood pressure is kept from going up by two factors. The first is the viscosity of anemic blood. Viscosity is the quality of a fluid which tends to cause it to resist being propelled through a tube or opening. Thin, anemic blood is less viscous than normal blood and can be pushed through the vascular bed with less pressure. The second factor is the blood vessels themselves. The wall of each small artery or vein contains one or more layers of muscle capable of responding to nerve signals by contracting. This causes the vessel to close down to a smaller caliber and be more resistant to the flow of blood. Other nerve impulses cause the muscles to relax, letting the vessels expand to a wider caliber and allowing more blood to flow with less resistance. In the anemic patient, the brain sends signals to the muscles around the small vessels telling them to relax and open up. The result is less impediment to the flow of blood. Therefore, because of less peripheral vessel resistance and thinnet, less viscous blood, the cardiac output can rise without causing the blood pressure to go up. "
frijole
"At 7.5 or lower there is an serious risk of a heart attack and a possibility of brain cells dying from not receiving enough oxygen. "
Where did you get this information? I have never heard this and would like to know more. I'm week 22 and have had anemia (hgb beween 8.5-7.3) since week 6.
Where did you get this information? I have never heard this and would like to know more. I'm week 22 and have had anemia (hgb beween 8.5-7.3) since week 6.
My hemo went down to 8.6 at 16 weeks.
The doctor reduced my riba from 1200 to 800 per day, and has been testing it weekly. It's gone from 8.6 to 8.7 then to 9.1 and most recently 9.0 at 20 weeks.
Reduced hemo is a very common side effect. As long as it stays above 90 you don't need to worry, but the concern is that once it gets down to 9.0 or 8.5 it may continue to drop to a dangerous level. At 7.5 or lower there is an serious risk of a heart attack and a possibility of brain cells dying from not receiving enough oxygen.
The doctor reduced my riba from 1200 to 800 per day, and has been testing it weekly. It's gone from 8.6 to 8.7 then to 9.1 and most recently 9.0 at 20 weeks.
Reduced hemo is a very common side effect. As long as it stays above 90 you don't need to worry, but the concern is that once it gets down to 9.0 or 8.5 it may continue to drop to a dangerous level. At 7.5 or lower there is an serious risk of a heart attack and a possibility of brain cells dying from not receiving enough oxygen.
Thank you for your post stormy...It just is not how the hep c docs roll on my plan. I am sure that my family doc will do one in a heart beat if I ask. Am happy for the riba reduction as well. More to be revealed. :)
Why aren't' they doing weekly blood draws, please? Glad they reduced you, hoping you have a big, immediate bounce!
Thank you so much for your post. Everyone is most helpful on this site. I really appreciate all of you. :)
Good Morning Billy...Thank you for your post. Docs office just called with a riba reduction from 1000mg to 800mg, 2 capsules twice a day. Next blood draw is 6/19/2012 for the 12 weeker. Yes, I will keep an eye on my strength and such. Thank you for your support, again....:)
once a week cbc is the way to go with low #....but 9.3 isn't that bad...and 1 point in two weeks isn't really tanking although your probably not feeling too good...take it easy...be extra careful...its funny how low hgb affects people differently ...there are some that can exercise and work all day in the 7s and 8s but for me mid 8s and i couldn't stand up on my feet for more then maybe 5 to 15 minutes most of the time..when i was in the 7s it was really something....i also was on an ad (zoloft 150 !) which may have made the tired feeling worse..but not much anxiety....also i think it might have something to do with what your hgb is normal...mine was 15.5....i'm still not back to that yet 7 months post tx but getting closer..in fact feeling really good....good luck..low hgb can be tough...billy
Hey there,
I found out that my hgb. is now at 10. With that my doctor has ordered an xtra blood test for next week. Again I see that there is no set choice for procrit vs. ribavirin reduction. I think it could be a tough decision. Looks like hrspwrguy has given you some good info.
Take care,
C
I found out that my hgb. is now at 10. With that my doctor has ordered an xtra blood test for next week. Again I see that there is no set choice for procrit vs. ribavirin reduction. I think it could be a tough decision. Looks like hrspwrguy has given you some good info.
Take care,
C
Thank you. I was UND at week 4 as well. Hep c doc said it is quite the mess to get hooked into the procrit aspect of recovery. It seemed to me they did not like that they would lose some of their control of dosing...I totally agree with once a week testing. They like one a month. I will find another doc to do my blood work at my expense need be.
Considering you were UND at 8 wks and that you are at a 9.3 your doc reducing riba would be following AASLD protocol, you should discuss the possibility of adding procrit (erythropoietin) if your HGB continue's to drop after reducing riba.
Thank you so much. I think that I understand. My hep c team told me earlier they will reduce riba if need be first. I will hear more from them tomorrow...maybe...if they find the time
Thank you my friend. I appreciate your input. My regular doctor ordered a blood draw yesterday when I met with them for my mouth thrush appointment. She was surprised that the hep c folks would wait a full 4 weeks between draws based on the recent ER adventure. I thanked her for her concern and now see the results had that she suspected. My hep c team is a train wreck. On my last monthly med pick up I was shorted half of my Incevik. Instead of being in 2 boxes in came in 5 large cylinders. I asked the pharmacist if we could make sure it was the correct med as I had quite a commute back to my home. It was the right med but only half of it I discovered after getting home and paying full co pay for it. With only 2 days left of the meds the hepc folks after telling me on 4 other occasions that it had been mailed to me tell me today they had failed to mail it. I just do not feel safe in their care or lack of it. So very frustrating.
Anemia developed among recipients of both PIs. Hemoglobin decreases below 10 g/dL (grade 2 toxicity) occurred in 49% of patients who received a BOC regimen compared to 29% of those who received the SOC regimen, whereas 9% had a hemoglobin decline of <8.5 g/dL (grade 3 toxicity).12 Among patients treated with T12PR, hemoglobin levels of <10 g/dL were observed in 36% of patients compared to in 14% of patients who received SOC, and 9% had hemoglobin decreases to <8.5 g/dL.16 Because hematopoietic growth factors were not permitted during the TVR trials, there was a 5%-6% higher rate of treatment discontinuation among
those who developed anemia than among those who did not. However, neither anemia nor RBV dose reduction adversely affected the SVR rate. Of note is that in the BOC trial, SVR rates in patients managed by RBV dose reduction alone were comparable to those in patients managed with erythropoietin therapy.23 Similarly, in the TVR trials, dose reduction of RBV had no effect on SVR rates, and therefore dose reduction should be the initial response to management of anemia.24 Because the duration of BOC therapy (24 to 44 weeks) is longer than the duration of TVR therapy (12 weeks), the frequency of anemia is likely to be greater in BOC-containing regimens, leading to more RBV dose reductions and consideration of erythropoietin use. However, the potential benefits of erythropoietin must be weighed against its potential side effects, the fact that its use in HCV therapy is not approved by the FDA, and its considerable cost. If a PI treatment–limiting adverse event occurs, PegIFN and RBV can be continued provided that an on-treatment response had occurred. There are no data to help guide substitution of one for the other
HCV PI. If a patient has a serious adverse reaction related to PegIFN and/or RBV, the PegIFN and/or RBV dose should be reduced or discontinued. If either PegIFN and/or RBV are discontinued, the HCV PI
should be stopped.
https://www.aasld.org/practiceguidelines/Documents/2011UpdateGenotype1HCVbyAASLD24641.pdf .
those who developed anemia than among those who did not. However, neither anemia nor RBV dose reduction adversely affected the SVR rate. Of note is that in the BOC trial, SVR rates in patients managed by RBV dose reduction alone were comparable to those in patients managed with erythropoietin therapy.23 Similarly, in the TVR trials, dose reduction of RBV had no effect on SVR rates, and therefore dose reduction should be the initial response to management of anemia.24 Because the duration of BOC therapy (24 to 44 weeks) is longer than the duration of TVR therapy (12 weeks), the frequency of anemia is likely to be greater in BOC-containing regimens, leading to more RBV dose reductions and consideration of erythropoietin use. However, the potential benefits of erythropoietin must be weighed against its potential side effects, the fact that its use in HCV therapy is not approved by the FDA, and its considerable cost. If a PI treatment–limiting adverse event occurs, PegIFN and RBV can be continued provided that an on-treatment response had occurred. There are no data to help guide substitution of one for the other
HCV PI. If a patient has a serious adverse reaction related to PegIFN and/or RBV, the PegIFN and/or RBV dose should be reduced or discontinued. If either PegIFN and/or RBV are discontinued, the HCV PI
should be stopped.
https://www.aasld.org/practiceguidelines/Documents/2011UpdateGenotype1HCVbyAASLD24641.pdf .
That is quite a rapid drop. I began my Procrit shots at week 8, with my HGB at 9.4.
I take a weekly Procrit shot, of 40,000 units, and at week 12 my HGB was at 9.3 The Procrit takes around 3~6 weeks to start working, sometimes. So the sooner you start withthis rescue med, the better.
Some Doctors opt for ribavirin reduction instead, depending on the Doctor you are going to.
How are you feeling now? Please be careful now that your HGB is low like this, so you dont strain your heart. If you start feeling tired,it is important to stay quiet, and rest, so as not to strain yourself.
I strive to put very little stress on myself, with my HGB at this level.
There-fore, I have a larger than usual dirty clothes pile, and a house that needs dusting and vacuuming~
You have to jump into action right away, and push your Doctor. The Procrit will need a pre-authorization from your doctor, along with a copy of your lab result, and your Doctors signature, sent to the Specialty Pharmacy. This whole processs took me a month~
I take a weekly Procrit shot, of 40,000 units, and at week 12 my HGB was at 9.3 The Procrit takes around 3~6 weeks to start working, sometimes. So the sooner you start withthis rescue med, the better.
Some Doctors opt for ribavirin reduction instead, depending on the Doctor you are going to.
How are you feeling now? Please be careful now that your HGB is low like this, so you dont strain your heart. If you start feeling tired,it is important to stay quiet, and rest, so as not to strain yourself.
I strive to put very little stress on myself, with my HGB at this level.
There-fore, I have a larger than usual dirty clothes pile, and a house that needs dusting and vacuuming~
You have to jump into action right away, and push your Doctor. The Procrit will need a pre-authorization from your doctor, along with a copy of your lab result, and your Doctors signature, sent to the Specialty Pharmacy. This whole processs took me a month~
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