Pcr good Hgb bad

My lab report came back undetectable at 4 weeks. I'm so excited I want to frame the darn thing!
My hgb is down to 10 tho and she wrote me a prescription for procrit. Should I fill it or wait to see if goes up. She said that I need to pace myself more, I saw her the other day and was full of energy. Today I feel like ****. But the lab report makes it worthwhile. I would have been satisfied with a 2 log drop. Thanks for all who led me into treatment, I hope it continues to work and pray for everyones recovery.
Thank You God!
Bug-less

[jmjm530]

Congratulations on being non detectible at week 4. This is pretty much as good as it gets. Definitely start the Procrit ASAP, as it takes 2-4 weeks to kick in and you don't want to risk your treatment by getting too anemic. Unlike ANC, hemoglobin usually does not bounce up and down significantly, but usually just heads south without helper drug intervention. Also, do you know the sensitivity of the test you took? If it was over 50 IU/ml, ask your  doctor for a very sensitive next time like Heptimax which goes down to 5 IU/ml.

All the best,

-- Jim

[ladybug52]

I should have known you would ask. I was scheduled  for the heptimax 1/5  but Wed I changed dr's. She gave me a lab slip for HCV RNA quantitative real time pcr. I was <50 IU/mL, <1.70 logIU/mL. Hope thats good enough to qualify as undectectable.
My pcp had ordered the heptimax, I had asked for that test because of your advice. However when I went in Wed I was more than happy to get any test that showed some progress. My hgb was drawn Tues by the first dr. Some days I have so much energy I can't beleive that it's dropping. I was at 14 in Nov. Guess my ADHD makes up for low hgb, and here I always thought it was nuisance.
Thanks for your help
Janice

[FL_Gal]

Yippee!!!!!!!

I would frame the report.  Looking at it will get you through the days when you wonder if this is all worth it.

[jmjm530]

A real time PCR that goes down to 50 IU/ml is pretty good and in fact was (and maybe still is) the non-detectible standard used in most European trials.

That said, you probably want to ask for Heptimax or something similar next go around - or if you're neurotic like me, consider re-testing at week six with the more sensitive test.

Another alternative is to have your doctor instruct the lab to run another test using the week 4 blood draw if enough blood is still available and usable. That way you will get a week 4 result as opposed to a week six result. If available, I would suggest they re-test the sample with Quest's "HCV RNA Qualitative TMA" using the Bayer Versant Technology. This particular test goes down to 5 IU/ml which is the same sensitivity as Heptimax but would not have to duplicate the PCR portion. Congratulations again on your result.

-- Jim

[GoofyDad]

Don't mess around with that procrit. I farted around with spacing doses because I didn't want to over drug -- let my body respond --- blah-blah-blah. Ended up in the hgb toilet and had a hell of a time getting out. Barely negotiated maintaining full dose with the doc who was worried he was gonna kill me. Felt pretty crappy too if I recall, which I barely do.....

[jmjm530]

Goof:  Don't mess around with that procrit.
---------------------------------

What Goofy means is make sure to take Procrit or you can get into trouble with anemia. I read it the wrong way at first, and possibly some others might as well. I remember well the trouble Goofy had when he started skipping some Procrit doses. Had some problems myself when I stopped dosing Procrit weekly and went to once every other week. Hemoglobin dropped quickly and had a hard time getting it back up.

-- Jim

[Lady E]

Yay!! Congratulations to you girlfriend!!!!! You are doing great!!
((huge hugs))
-E

[scubadiver30]

The best of the best. it feels good doesn't it?
Jim, my doctor told me that the standard in Europe goes down to <15 UI/ml Roche Amplicor

[chcnme]

Bug! That's great news! I bet you're so happy on that 4 week PCR that you broke all thermometers resting in your back pocket jumping for joy!  Fill that procrit and do it!  (10? that's getting LOW - haven't you feel like crud at 10?)  Well, if you did feel cruddy, I bet that 4 week PCR sure gave you a  boost :)  Congratulations!

[friole]

Great news on the UND.  I like Jim's suggestion of trying to get another more sensitive test done on the first blood draw.

I agree with Goof too -- get the rx filled.  I think a lot of us thought we would only occasionally need the Procrit.  But the reality is that you will probably need it for the duratin -- especially if you are at 10 hgb already.  I don't think I started until about week 12 -- that was when my hgb went to the 10s.  And I too thought I would only need it every other week but that didn't last too long.  

Hey Goof - how are you doing?

[AMAZED]

Congratulations!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!  I am thrilled for you.  Go ahead and get the px filled for the procrit.  I agree with Goofydad,  don't wait until things get worse or it drops even more to a point that you can't pull yourself out of it.  YOU derserve this, Janice!!!  

FAITH keeps looking up,
Rick

P.S.  Yeah framed that thing thing baby!    Go, Janice.....Go Jancie....... it's your birthday.......go Janice...........I am doing the happy dance for you........

[AMAZED]

Janice.......I KNOW that I can do this now.  What an encouragement for me to hear this news............BTW do you know what your hgb was before you started the tx?  Just curious?  

Faith keeps looking up,
Rick

[amommy]

Congrats!!!!! This is awesome news.  I'm joining Rick in doing his happy dance. :)  And, like the others have said, use the procrit!!!!!

[honey11]

Bug,,,Great News!!  You definitely can't beat an undetectable on a 4 week PCR!!!  Just to know that you are clear and on your way to SVR will keep you going!  Congratulations!

[GrandOak]

Congrats and ditto on the Procrit!!


Their product insert says 2-6 weeks to see a response and like many of these meds, each person is different.  For myself, it seemed about 3 wks before I seen any response to the Procrit, or changes to dosage adjustments.

Hopefully they have you scheduled for more frequent CBC labs, preferably weekly I would think, to watch as you begin the Epo regimen and establish what you response time is as well as monitoring that you do not rise to fast or high.

The danger of too quick a response is that you could overshoot normal ranges, although this seems highly improbable with this meds for this tx if you are experiencing the anemic sx, as it can result in increased clotting.

It's also good to know what your response time is in case, like myself, you need to make further adjustments as your tx progresses.

As others can atest, you really don't want to go too much lower as the fatigue can really knock the wind out of you.

Also, keep in mind that your first from into the anemia always seems to be the worst as far as how you feel goes.

[mikesimon]

Congratulations on the great news! I agree about the test sensitivity but because it is only been 4 weeks I wouldn't give it another thought - except to make sure the next one is more sensitive. I agree with everyone about Procrit - take it now. We all want to try and wait & see if it doesn't rebound w/o the drug  but that isn't the smart way to go with a falling Hb. Good luck. Mike

[sallyo]

Hello,  having trouble understanding the difference between HCV qualitaive and PCR.  Anybody? My tests are HCV quantatative. Maybe someone can explain these tests like I'm 4 or something because I know they have been discussed before and I'm not getting it.  Thanks

[GoofyDad]

To clarify, I was prescribed 40,000 units/wk on week 2 or so. I negotiated to try every 10 days first. That seemed to work for a few weeks and then I started a slide that took a long time and a lot of procrit to reverse. If I had it to do again, I would be more agressive to stay in front of the hgb curve instead of playing catch-up for months.

[jmjm530]

As to what day to take your viral load tests, best day is the day before your injection, or the day of your injection, but before the injection. That way you will get a conservative "trough" reading.

[mkeela]

AWE BUG!!!! I am soooooo, sooooooo, happy about your PCR!!!! Outlook: GOOD, FANTASTICO, WONDERFUL!!!! You'll be in my prayers for the HGB. Love, Mequila.

[mikesimon]

Qualitative RNA detects <B>if</B> you have an active HCV infection.
Quantitative RNA determines <B>how much</B> active HCV you have - <B>viral load</B>.
Antibody test determines whether you have ever been infected.
Mike

[sallyo]

I am also happy for your good lab results. I also agree that taking the procrit will keep you from problems down the road.  In my experience, the Procrit kept my HBG around 9 or 10,  Even though I didn' get a rise in the HBG and still felt a little sluggish, it allowed me to continued the tx.
  Mike simon:  thanks. think I got it now

[painterlady13]

E, That is so wonderful about the PCR... and I will chime in with everyone else on the Procrit, Do It ASAP it takes a few weeks to work and during that time your HGB could get lower before it gets better. Congrats again
Nicki

[ladybug52]

Thanks, I have so enjoyed reading the respones! Hey even a song! I just want the same success FOR everyone else.
JmJm thanks for always sharing info, sometimes I'm a little sluggish on the processing tho.
Mike Simon thanks for the info. Where were you when I posted back in Nov quantitative vs qualitative pcr? I like how Sallyo asked you to explain it as if you were talking to a 4 yr. old. That cleared it up for me.
Fl_Gal/LadyE thanks now I need to quit smoking and I am making that committment since you two were able too. I'm such a closet smoker and hate those evil little things. It all started last year when I wanted to lose weight for my daughter's wedding...
Goofydad:I'm not buggy in more, that's MS Bug-less calling out from down here in the hgb toilet. Haven't got new ins. card yet and I am pretty sure the drug isn't cheap, and I am. Cheap about paying out of pocket that is! I'm sure you would never take that wrong.
Scuba:thanks, I share your joy, glad your hgb is still slightly ahead of the game
Chcnme: Thanks! Your right about both things, the broken thermometer and jumping up and down. I could tell the way the PA backed off she was sure I was going to throw my arms around her and I was!
Friole: You gave me a big boost when I was down in the past. No one knows how much we rely on each other better this ousider looking in!
Elaine/Rick: I love you both, really! Thanks for the e-mails.

[ladybug52]

They would never get me off the stage at the academy awards:
Amommy: Thanks for the dance. You and Rick are really good dance partners!
Honey: Your name says it all. I was reading some of your posts the other night in the archives. Sounds like I need a life huh?
GrandOak:Thanks for all the advice and the sharing of your faith, I love your attitude. I am scheduled for weekly labs, thanks.
Strator: What a beautiful voice you have! I especially like how you held those last notes! Now this gives me more energy for the whole marketing thing for your artwork, journal, movie and tv series!
Mkeela: Thanks sweetie, I'm glad you're almost done. Hang in there

[ladybug52]

Didn't mean to post that quite so quick, my fingers are faster than my brain. Thanks for congrats and advice, I have an ins. issue right now, I hope to fill the procrit by Monday. I'm just so jazzed that the viral load dropped it's hard to feel too bad. I usually have to eat my words later, pretty common with impulsivity!

[jmjm530]

Another way of looking at it is how the results are reported.

A quantitative test result will either give you a number such as 100 IU/ml. Or, it will tell you that you are below the detection limit of the test, for example < 50 IU/ml, assuming the detection limit of this particular test is 50 IU/ml.

A qualitative test result on the other hand will either say: "Virus Detected" or "Virus Not Detected", or some similar language. The "Virus Detected" means virus was detected at or above the detection limit of the test and "Virus Not Detected" means virus was not detected at or above the detection limit of the test. In most cases, the detection limits of a qualitiative test are very sensitive such as 5 IU/ml.

Because the quantitative gives you a number, it's always a good idea to order a quantitative test pre treatment and during treatment until the virus becomes non-detectible to it's limit. After that point, you can order a qualitative test because then all you really want to know is if the virus is detectible or not, the number being less important as in the case of a viral breakthrough or relapse.

A test like Heptimax was designed so you (and your doctor) don't have to worry about which type of test to order. Heptimax is a very sensitive quantitative test in two steps using two types of technolgy -- PCR technology and TMA technology. Because Heptimax is a quantitative test, in all cases you will get a number if you are at or above the detection limit of the test which is 5 IU/ml, the same sensitivity as the very sensitive qualitative tests.

Personally, I used Quest's Heptimax during treatment but once treatment was over I switched to Quest's HCV RNA Qualitative TMA which also has a sensitivity of 5 IU/ml. I did this because all I really want to know at this point is if I have detectible virus or not. Heptimax would have done the same thing but I kind of like the way the qualitative tests report their results. In big capital letters it reads "VIRUS NOT DETECTED". I like that :)

-- Jim

[ladybug52]

I still have the lab slip for Quest for the heptimax. Should I get the test taken on Mon? I'm sure they did not save my blood from Wed.'s test, or wouldn't even try to call and ask. I was so set on the heptimax and the PA agreed to write it but I just wanted to be agreeable. I find it hard to be very proactive in my own care when someone is nice to me. If they aren't then I go into my fight or flight mode. Thanks for your help.
Janice

[FL_Gal]

One thing that helps me in continuing to not smoke, is that I never want my grand-daughter to see me with a cigarette in my hand.  Put the cigarettes away now, while you can't breathe and don't want one anyway(LOL), then if you find yourself wanting one later, just think about your grand-daughter watching you smoking, or worse yet, imitating you.

[ladybug52]

You know that worked for about26 years while I was raising my own kids, I would never have started the habit if they hadn't all grown up. I am very sure it's pretty much their fault! JK. You're advice is wonderful tho. I can quit for my little Taylor.  I did smoke 2 today but I have not wanted one since I left work. I hope I can do this.
Janice

[jmjm530]

Labs routinely keep blood for a certain amount of days after tests are run. Cannot hurt to find out if they are still holding your blood and have enough to run the test I mentioned. In fact, while the labs often don't like to speak to patients, sometimes you can get them to answer some basic questions if you firmly explain   you're not going to ask for their precious results but just want some general INFORMATION :) In other words get a supervisor and ask if they have enough blood to run the test mentioned -- or alternatively have your doctor ask them.

Aside from that, or if you don't want to get your second doctor involved, second best would be to run another sensitive test right away like the one I mentioned or Heptimax. If you happen to have an rx for Heptimax handy, then that sounds like the easiest to me.

All the best,

-- Jim

[strator]

(To the tune of Strangers in the Night)

Ladybug52, told those bugs to shoo,
Wondering in the night.
What were the chances, she

[ladybug52]

And what is a conservative trough reading? I've heard of peaks and troughs when monitoring abt levels in the blood but is a trough the low side? (since peak sounds definitely at the high level) Since I don't have ans ins card and my injection day is Friday what do you recommend? Thurs or Friday? Thanks.
BTW I guess I was using undectable wrong, just not detectable over 50?

[jmjm530]

If your injection day is Friday you could take your viral load test either Thursday or Friday, just as long as it's before the Friday injection. A conservative "trough" reading refers to the trough in terms of the interferon. In other words, the interferon will be working stronger after the injection and the weakker right before the next injection. You were using the term undetectable correctly, it's just that undetectable is always in terms of the sensitivity of the test you're taking. In your case the sensitivity was 50 IU/ml. In the case of Heptimax, the sensitivity will be 5 IU/ml.

-- Jim

[Cindy10]

Congrats, I am so happy for you. What a way to start the new year!

[dyce]

Way to go ladybug!!!!

Procrit as the other guys said is a must, my worst times on tx was when the anemia set it.

I know your proud of the 4 week early responce, this is great!!

Your on the right road, Goodluck!!

[merlino]

Wonderful News!!!! Its one of the best feeling I ever had. Kept me flying the entire day. Please be careful with your HGB. Anemia is a total nightmare. If your dr say ok to the procrit go for it asap.

[ladybug52]

Thanks, I'm arguing with ins to get it ASAP. This is probably the worst I've felt, but the good news is I lost my job today and don't have  to go back to work till I feel better!
Bug