Timing blood work?

In the past three months my blood count has been dropping (white blood area) during treatment.  I am injecting week 34 today of 48.  What I am wondering is if giving my CBC toward the end of my Peg week effects the results.  I was thinking about when I have been taking the tests over the whole treatment and I realized that in the beginning I was testing on the 6-7 day as opposed to lately testing on day 3-4?? Any ideas?

[willbb]

  The idea behind injecting INF.once a week is too keep the levels at a steady state in the bloodstream.I would doubt  that when you are doing your CBC"s would have any bearing on your whites cell reading.

Will

[spectda]

In your post a couple of days ago your WBCs and ANC were in low but safe zone. Your doctor shouldn't be considering dose reduction and if your anc dropped to 300-500 you should be prescribed neupogen.

With either pegasys or pegintron the level of interferon in your blood drops by the end of the week, although if you are using pegintron it drops much more drastically. because of this your WBCs and ANC may drop the first few days after your injection, and may rise a bit towards the end of the week. For some the difference can be huge and for others not so much.

I would suspect that testing at 3-4 days after ifn would be best but I don't think it matters in your situation because your levels are not that low, unless something changed since your last post about this.

34 of 48 weeks, you are getting there! it's good to get that time behind you know that there is light at the end of the tunnel.
Good luck,
Dave

[willbb]

Dave... The reason I thought whites would not be affected as specifically as one day vs.another during the week was because when I stopped treatment my ANC only recovered marginally during the next 14 days then slowly kept rising.
  
  Given that...... I would think testing on day 3 vs. day 6 would have very little effect on the level of Anc.

If I am incorrect in assumming that,please let me know .

  Hope you are feeling well..
Will

  

[Trish77]

You might find minor fluctuations in blood counts throughout the week - some people who wanted to raise their white counts slightly were advised to run up and down stairs before a test, apparently this works! - but a steady decline over months seems to indicate an overall ongoing hit to your white counts from the interferon.  Not uncommon.

I recall that your doctor has talked about reducing your dosage as a response.  While neupogen is indicated in that 300 - 500 range to bring white counts up, what matters is when your doctor will dig in the heels and insist on a dosage reduction - and how long it will take to get the neupogen in place if your doctor agrees to that.  There is  nothing wrong with taking neupogen before it gets to that 500 or lower range.  If your doctor has a firm dosage reduction cutoff of 500 for example, then you want to avoid that cutoff and introducing a rescue drug like neupogen before it gets to that firm dosage reduction cutoff is one way of doing that.  

So…if you're willing to introduce neupogen, you might want to have that conversation with your doc to know where your doc's head is at and determine your strategy - mine wasn't crazy about using neupogen and some aren't.  Each has different ideas about how much risk they're willing to take with how low they'll let white counts drop before an intervention of either a rescue drug or dosage reduction.  Neupogen acts fast but only once you have it in hand and can actually inject it so you'd want to get the "paperwork" started early enough to introduce it in a timely manner if it's a "go".  

Good luck.

[spectda]

"Dave... The reason I thought whites would not be affected as specifically as one day vs.another during the week was because when I stopped treatment my ANC only recovered marginally during the next 14 days then slowly kept rising.
  
  Given that...... I would think testing on day 3 vs. day 6 would have very little effect on the level of Anc."

Hi Will-
I think you are correct when I think about it. Considering it has taken this long for PJ to get even close to needing neupogen she may have minor fluctuations as Trish said but they are unlikely to be more then that.

I suppose I was focused on my own experience which was really not relevant here. For people who have their anc drop quickly early in tx and who need neupogen the fluctuations between neupogen and ifn injections can sometimes be pretty extreme, I know that mine were, but perhaps that is the exception rather then the rule.

I've got to be careful in the future. Being put in my place by a couple of Canadians can be humiliating, you people are scary  :)

[pj1881]

Thanks everyone! My doctor never even told me about a rescue scenario?? She told me that my next blood test will determine a dose reduction dependant on if my WBC count drops below 1.5.. I injected shot number 34 today, and I was sure to bring the measurement to 180 instead of just injecting all of what is sent for adjustment (like I was doing before).  I am drinking tons of water and hoping to keep my level high, my doc (female) is a real character, if I suggest she does something I heard about on the internet she will probably tell me I am an A hole.  This is some ride let me tell you!

[Trish77]

And what would your doctor say if you brought her in studies and research on it instead?  I can see some docs not paying much attention to something you read on the internet, however back that up with some valid data and I wonder if she'd pay a little more attention.  If you want them, I'm sure we can pull a bunch up for you.  

[Fnzol]

some people who wanted to raise their white counts slightly were advised to run up and down stairs before a test,

Lulz.  Advised by their mortal enemies.

That would freakin' kill me.  And I was a weight lifter and race walker before treatment.  My crit dived so badly that typing this makes me breathe hard.  

[Trish77]

"Lulz.  Advised by their mortal enemies."

Possible. :)  It was mentioned on here and some could...though admittedly, I might have made it up one flight and down again...but would have been done halfway up again and that's best case scenario.  Mind you, when hypothyroid, I felt like I could fly.

Just the same...there's a bit of science to that theory.  Might help to at least go for a 30 minute walk if capable of it before a CBC if you want to keep your white counts out of range of an over-cautious doc.

http://www.nlm.nih.gov/medlineplus/ency/article/007165.htm

Interesting, eh?