Need some info, please on ANC counts

Just want to be prepared for my Dr visit today so I need some info.
At what level ( number) does your ANC have to be to warrant the rescue drug, neupogen? On my last visit my Dr made a comment that if it gets under 1000, it can sometimes warrant stopping treatment.  At that time, it was 1076.  I know that I have read on here that it can be lower than that and still be safe.  Since she has listened to me thus far, I need my ammo for a good argument, if needed.
Also, my platelets last visit went from a starting number of 199, down to 99, if that makes a difference in any of this. That seems really low to me when i see people on here with platelet counts in the thousands.
Thanks! ~Debbie

[willbb]

Debbie

Absolute  Neutrophils count(ANC) is the main defender of the body in regards to fighting infection. It is a percentage of the total white cell count and the normal value is (quite broad(1500- 7000)
they often are depleted significantly during treatment ,however most doctors will let it go to <600 or even <400 before they would intevene with  the rescue drug nuepogen....A knowlegable doctor would never discontinue treament with an ANC of 1000.

Plats at 99 are not in the danger zone either...they can go as low as in the 20"s

Good luck going forward..it looks all good from here..
Will

[flcyclist]

Debbie, it depends on the doctor and how comfortable and familiar they are with treating patients undergoing trt.  My hematologist doesn't like to see it go below 1,000 either, but my GI didn't initially get concerned until it went below 500 - it was in the 300's at wk 8.   I've seen references to either 500 or 700 for the ANC, but not sure if I can find anything published to present to your doc.  

Most people respond very quickly to neupogen, so there should be no reason for dose reduction or stopping trt.   Some people have some minor sx from neupogen, but I haven't experienced any.    I have no experience with platelets, so hopefully those more knowledgable can help there.  

[can-do-man]

Your platlets are fine, a little low but to be expected.... Mine run in the 80's off of tx so not to worry there.

As for your ANC most wouldn't worry unless they dropped below 500, mine got as low as 300 without much concern. They seemed to bounce around alot on tx.

Good luck

[elpasolady]

I needed some quick responses and  you didn't let me down!  Thanks guys!  This info is just what I needed.

[mikesimon]

Viral Hepatitis
Risk factors for infection during treatment with peginterferon alfa and ribavirin for chronic hepatitis C

Article first published online: 29 JUL 2010

"...Infections were not correlated with neutropenia during treatment. Dose reductions did not lead to a decrease in infection rate. Multivariate logistic regression analysis revealed that age >55 years (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.19-3.56, P = 0.01) and baseline hyperglycemia (OR 2.17, 95% CI 1.15-4.10, P = 0.016) were associated with an increased risk of infection during HCV treatment. Cirrhosis and chronic obstructive pulmonary disease were not risk factors for infection. Conclusion: Bacterial infections during treatment with peginterferon alfa and ribavirin are not associated with neutropenia. Older patients and patients with poorly controlled diabetes mellitus have a greater risk of developing infections during HCV treatment. (HEPATOLOGY 2010)"

http://onlinelibrary.wiley.com/doi/10.1002/hep.23842/abstract

[MagTX]

Here's a little more info but I think you've gotten a great response here for what you'll need to know, anyway..
Each doc has their own protocol for when they feel they need to prescribe rescue meds.  My hep doc gives neupogen if anc is near 500 or below.  

Hope you have a good visit today, oh and stay clear of anyone coughing or sneezing,(lol)  and use hand sanitizer... I always did on tv, and still do!!!  :)

Maggie

[frijole]

el paso

I know you are comfortable with your doctor and you are her first Incevik patient, but I worry when she says you might have to discontinue treatment if ANC drops below 1000.  I would not have taken neupogen at all if the doctor did not insist, first round.  I like that article Mike found.  Perhaps you should take that to your doctor.

frijole