Red blood cells

I am at week #11. Became anemic at about week 6. Started procrit at 400000 units per week. At 3rd week increased to 60000 as blood was still going down. Blood prior to 4th shot starting to improve. Went today for 5th shot and numbers are going down again.

Here are the #s 5 days after each shot
                      hgb    hct
At procrit start      9.2   26.4
1 week after 40K      9.3   27.6
another 40k 2nd wk    8.7   25.1
1 week after 60K      9.3   27.8
another 60K           8.7   25.4

I had another 60000 today and will do cbc next Monday. Hemo doc says not to worry and will do blood transfusion if hct goes much below 25. Hep doc is talking about cutting back on riba. Neither one wants to up procrit or give it more often.

I am a gen2 and have one week to go to be 1/2 way. I am on 180 pegasys and 1000 riba / day. I read somewhere that after week 12 if riba is reduced your chances for SVR are still good. Also, I know that many 2s only do a set 800 riba.
I was und<50 at 4 week pcr.

I appreciate any advise.

[traveler65]

Sorry first sentence should have said 40000 procrit not 400000.

[jmjm530]

While some here have taken over 60,000 units/wk of Procrit, in general that seems about max and my medical team told me they wouldn't up me beyond 60,000 units.

Tranfusion is definitely one way to keep you on tx without reducing your ribavirin.

As far as reducing the riba instead, it's a real judgment call, and yes, many geno 2's treat with a fixed 800mg but the newer trend seems to treat weight based.  How much did you weigh when you started treating and what's your weight now? How much liver damage do you have? Were you non-detectible at week 4? Oh, yeah, I think I remember that one :)

-- Jim

[traveler65]

Weight at start of tx was 180. Weight today 175.
Don't know liver damage as doc felt that biopsy was not necessary w/gen2.
Was RVR <50 at week 4.
Wondered about the transfusion as I had not read of anyone having it. Hemo doc says quite routine and that a couple of units will keep my blood up for more than a month. Procrit would still be continued.

[jmjm530]

I'll let you do the math, and as mentioned, weight-based riba is the ideal, but then again sometimes we have to compromise on treatment:

"...Patients in a community setting with CHC were randomized to PEG IFN alfa-2b 1.5 ug/kg once weekly plus RBV 800 mg/day or RBV based on weight: < 65 kg

[madbrad]

My question is,
Did your Doc take you off RIba or at least reduce the dose?....I'm not a doctor,but in my experience I went anemic at 10,and by 12... I was bad anemic...By this time I had achieved <50....But they took me off Riba, and slammed me with 40k units of EPOetin,then a 20k per wk maint till my Hmg/MCT stabled out....I was 7.4......They kept me on it for 6 weeks then put me back on riba @ 400mg's when my Hmg hit 12.4...The did another VL and enzy check....and put me back on full strength 1200....But by now I came back No HCV RNA Detected....... And I'm geno 1....
    I'm just curious as to why they didn't take you off Riba till you stabled out since your <50???
    

[madbrad]

Forgot to add ....Good for you being UND at 4 th week....

[ladybug52]

You're pretty tough! I don't doubt Jim's right about the new trend to weight-base riba, but I had never heard of that for a geno 2. Actually, I remember asking my dr if my dosage was weight-based and he said yes. I was just spouting things I'd heard on this site and didn't know that dr's treated differently for different geno types at the time. Along the way I learned us geno 2's were given 800mg, and coincidentally, that was weight appropriate for me. What am I trying to say here? I guess the question is how do you feel about a transfusion? Which scares you more, lowering the riba to 800 or getting transfused? Which dr's judgement do you trust more? They are going to have to get together for your sake, good luck. You must feel pretty bad with those blood levels. Be careful! No running up and down stairs or jumping around in the shower:)
Bug

[orphanedhawk]

I just saw my liverhead. He's really great,part of the Gish group research team. I'm a geno. 2 and had my riba increased knowing that it could cause anemia. Slowly my rbc's are lowering. My doc says if I get down to 10 we can either give me procrit or reduce the riba. We left it at that.
   Good luck.

[traveler65]

Still on 1000 riba as my hct is above 25. Hemo doc would rather keep me on riba and do transfusion if hct drops below 25. Hep doc is leaning to reducing riba to 600 per day. I need to get them to talk. Also, I would like to keep riba at least at 800.
Just hope this shot today of 60000 will start hct moving up again.
As I said to jmjm I was really wondering about transfusion as I had not seen it mentioned before.

[madbrad]

ooooooooops...I also forgot my HCT was 22.1......

[painterlady13]

Around week 4 my HGB went  from 13.9 to 11  Doc started Procrit, then 2 weeks later it had dropped to 8.7  my PCP ordered a transfusion of 1 unit.  Liver doc initially said no but then agreed that it would help for the short term  We did reduce riba from 1200 to 600 and then after the HGB went up we slowly reintroduced  more riba I am currently on 1000 mg riba and 60,000 Procrit.  Oh Now week 38/48 Geno 1b.  Can't believe it's almost over...
Hope this helps
Nicki

[madbrad]

I was more worried about having a heart attack and dying then reducing my Riba...If I'm dead theres no point to Riba......LOL
  traveler65
   It's not my life brother but I tend to lean toward A Hep Doc...Then anyone else,Their accustom to dealing with the sides.....
But heres my opinion...I think My Doc did it right.....By the time I went anemic I was <50 UND......Geno1 with 12.5 million copies,by week 10-11 badly anemic they took me OFF Riba..And administered Rescue...There's still a ton of Riba in your system...Gave me 40k EPO to boost me...I felt better immmediately,well within that week........See,taking me off Riba gave me a chance to produce bloodcells with destroying most of them on the way which would have kept me in the negative and struggling...Which really wasn't any point since I had already achieved UND......
     3 months later I'm......NO HCV RNA DETECTED = NONE.........where as I was detected to be less then 50..I think they knew what they were doing........Mines a Hepatologist......Not an OD.

[traveler65]

Thanks all, hep doc and hemo doc are going to talk today. I'm feeling OK so I will await thier decision.

[FlGuy]

A few people around here have had transfusions.  The one that sticks in my mind is Beagle Bailey who had two or three during tx.  He also has an unrelated condition that causes low hgb. Each time he had transfusions (takes a few hours) there was fast effect, unlike epo.  Think the doc is correct that transfuse is not all that uncommon solution, just less so for hcv than other conditions. I'd try to get a few more weeks in before reducing riba - if possible.