2 Week Labs~Anemia question.

[uncledudeness]

I just had my first appointment to go over my blood work. tonight is shot 4 and everything seems to be going good. the first thing my tx nurse said was "good news". i was all ears.
my AST went from 180 to 90 and my ALT went from 281 to 135. she said it's a sign that i am responding to tx.
my platelets went from 89K to 107K. that was a huge concern for me.
the only catch is that my hemaglobin went from 15.8 to 11.4.
RBC went from 5.05 to 3.61. and my WBC went from 6.7 to 4.7.
bilirubin went from 0.8 to 2.4.
hematocrit went from 46.83% to 33.2%.

the above bloodwork was at week 2.

so i am starting on Procrit next week. she said that i am responding quickly to tx and that she wants to control the anemia before it becomes any lower. i don't think i am experiencing any effects from the low RBC yet.

next week is the RNA test. i can't wait to see what the VL is....

any thoughts or explanations re: the above numbers would be greatly appreciated.....my initial take is that it's all very positive. can it really be true?

sidenote: i have been shoveling snow for several weeks now. yesterday may have been a bit too much to handle; but i did it and i sure did pay for it. she also said exercise is good, but don't overdo it.....what does overdo mean?   bwahahaha....

as always; thank you to everyone here for providing support....i am humbled by the showing of compassion.

[spectda]

Was the 10.9 level at week 3 and one week after you were at 11.4?

It sounds like after that initial first two week drop your hgb hgb might be stabilizing. You don't need to take procrit if your hgb is over 10 and I believe most insurance companies will not approve it and most doctors will not prescribe it at 10.9. If you have dropped to 10 at week four my guess is that blue shield will approve it. You still have a lot of room to drop your hgb safely although it feels pretty bad when it drops in the 9s and lower.

If you take procrit when your hgb is already at 10.9 you run the risk of having it go over 12 which is not safe. As long as you are monitored carefully you will be fine. You will get used to the lower level of hgb. Adjust your physical exertion to match your energy level, forgoing exercise and shoveling is a lot safer for the time being then taking procrit unnecessarily.

I truly understand the fatigue. I have been anemic from tx for the past 30 of 38 weeks of tx, even with procrit.

Good luck,
Dave

[uncledudeness]

thanks blue cross blue shield.....as of one week ago, my HGB was at 10.9, down from 11.4 the week before. my RX for Procrit was rejected. it seems that they want me to fall below 10, before they will approve it. now my NP is talking about a riba reduction....this sux, they suk....

insurance companies are the spawn of satan.

each week i feel worse, my breathing is becoming more stressed and the fatigue is peaking. i had my 4 week labs done yesterday and i should find out monday what my new hgb level is.

any advice? should i call  the insurance pukes and complain.

[mikesimon]

The increase in your total bilirubin was likely dues to an increase in indirect bilirubin caused by the destruction of red blood cells (hemolytic anemia) which resulted from treatment. It's not uncommon to see these types of changes while 0on treatment.

Mike

[uncledudeness]

absolute neutrophils is 3652
absolute lymphocytes 602


last september/2010
absolute neutrophils were 5099
absolute lymphocytes 951

i have all my data in a spreadsheet.

i am taking your advice BIG TIME about not shoveling. i was out for 10 mins and i packed it in.

thanks again for the help

[Trish77]

Thanks for the rescue, Bill.  Too many "thinks" on my part.  Going to get some air. :)

[Bill1954]

I independently checked this using an online ANC calculator using the numbers provided and also arrived at an ANC of 3.65:

http://www.mylan-clozapine.com/ANCCalc.asp

From personal experience, my baseline ANC was 2.50; at week 4, it reduced to 1.40 for reduction of 56%. Quest labs show a reference range of 1.50 – 7.80; I was only slightly below the listed reference range, and nothing was ever mentioned to me about any indications of pending trouble.

I never required GCSF drugs like Neupogen. Looking further into therapy, I see that my labs actually corrected somewhat; by week 32 my ANC had risen to 2.0, well within reference range; at end of treatment (week 96) still 2.0. I think it might be a bit early to predict trends, based on personal history anyway.

Take care and good luck—

-Bill

[Trish77]

You know...I'm getting a little confused whether your ANC is 3.65 or .365 and I think I want to take the "Call a friend" option ....so don't assume anything is amiss until it gets clarified further .....by input from other folks too.  

[Trish77]

On your hgb first - you should be aware that procrit can take 2-3 weeks on average to kick in but can take up to five weeks for some, as it did for me.  Your doc knows you're starting on procrit so a certain amount of leeway will be allowed, I'm sure. What's key is how you're tolerating so don't push it and take it easy and don't do anything crazy.  If you must shovel snow then take longer to do it or pay the kid next door, kinda thing.  I would simply resist a dosage reduction until the procrit has started to kick in, particularly on the first 12 weeks.

What's of additional concern is your ANC.  Your calcs look right to me.  Your ANC has also dropped considerably.  That's pretty low in general, let alone at two weeks.  I'm surprised your doc hasn't said anything about that.  Do you have a line on your blood test that says "Absolute Neutrophil Count"?  If yes, that's your ANC and what does it say please?

If your ANC is 3.65 and that's accurate....well, I'll wait for you to tell me if you see that line on your blood test.  If accurate, that's really low for 2 weeks into treatment and that indicates the level of vulnerability of your immune system.  You're getting down there.  Not meaning to worry you but I never did back away from straight talk ...that's getting low.  

Trish

[Bill1954]

Trish, we caught willbb the other day when he referenced the Canadian ‘boarder’. I thought nothing of it what with all the extra vowels y’all like to toss in to your colourful language :o).

Thanks for the smiles,

Bill

[uncledudeness]

i just love tangents; been on one my whole life...lol...

thanks for the advice and support everyone. on thing my hep nurse told me that caught me by surprise, is that heart attack and stroke potential is increased when you are anemic. i sat in my garage for half an hour trying to catch my breath...scary...not doin that again.

i forgot to mention that i don't start procrit until feb 11. if it takes 2 weeks to be effective, that's a month of falling RBC levels that can possible occur. i really don't want to reduce my riba intake....

ANC...i googled it and found an ANC calculator....wbc=4.7 x neutrophils 77.7%=3.65 ANC

i thing that's right?

[Trish77]

Sorry dude....went off on a tangent there on your thread. Happens alot on this forum.  The other thing to know on treatment....keep your sense of humour....uh...humor.  (that one was for Bill. :)

[Trish77]

"so  now you know  the remedy to "catch your breath" Less thinks!  :) "

As if ... I yam what I yam.  The only time I'll be able to achieve less thinks to be able to catch my breath is on the day I breath my last one...methinks. :)

[willbb]

So...it's conclusive then - doing both too many things AND too many thinks will lead to excessive windedness. :)

Yes...I would say that is true...so  now you know  the remedy to "catch your breath" Less thinks!  :)

[Trish77]

LOL!!  Nice catch, Will. :)  

Yeah.......I'd have to say I get excessively winded when I do too many "thinks" also. :)  Now there's a Freudian or whatever kind of slip if ever there was one, eh? :)

So...it's conclusive then - doing both too many things AND too many thinks will lead to excessive windedness. :)

[willbb]

"Take it easy on yourself and don't do thinks that get you excessively winded."

Hey Trish...I find that when I do too many  "THINKS " I get real winded to.  :)

WILL

[Trish77]

Sounds like your doc expects your hgb to keep dropping with a huge drop like that at Week 2 and wanting to keep that contained and that's a good response from your doc.

Potentially good sign to see your hgb drop so quickly.

Do you show a result for ANC and what is it please?

I think you already know what overdoing it is, when you pay for it when you shovel snow.  Take it easy on yourself and don't do thinks that get you excessively winded.  Drop in hgb lowers the oxygen in your blood so you have less "air" to work with.  So use it wisely. :)

Here's hoping on that Week 4 result!

Trish

[spectda]

Very good news and response to the ribavirin. Your hgb is dropping so quickly. The svr rate is quite a bit higher when people become anemic. Normally people don't start taking procrit until the hgb drops to 10 or slightly lower but your doc is trying to respond since the procrit takes about 3 or more weeks to bring your hgb level up.

You don't want your hgb level to go over 12 g/dl when on procrit. There are safety warnings about this included with the procrit information. Not saying that to scare you as many of us have taken procrit to get through tx. Your doc seems to be paying attention so I assume he/she is being cautious. I guess by the time you start the procrit you will have results from week four so the doc will know if your hgb dropped even more.

Good luck,
Dave

procrit info and precautions:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000913

[evangelin]

It sounds like you have a good Dr. ,as many  will reduce your Ribavirin first and then order Procrit. It takes time.  That caused a viral breakthrough for my husband on one of his TX attempts.  The next time, I insisted that before we start, they needed to get Procrit ready because history said he'd need it soon.  We had changed Dr.'s and this one readily agreed.  The Gastro we had before this would not have been likely to be persuaded..  They used a cookie cutter approach , no matter what.
It does sound like you are a good responder and your Dr. sounds like a keeper.  That is wonderful news.
Best wishes for a succesful TX,
Ev

[willbb]

Hey friend..those are all good numbers.....the  reds dropping like that means you are getting good absorption on your RIBA  and thats great.  Just take it easy ,you will be fine   and good luck  on wk4 vl !!

WILL

[frijole]

Those are nice labs.  That is a really big drop in hemoglobin for two weeks on treatment.  Even if you don't feel it yet, I imagine you will before the Procrit takes effect.  It takes awhile for it to work.  Procrit burns a little going in.  IT helps to warm up the vile between your hands and inject it slowly.  It is a godsend for those of us who got anemia.

You won't be able to shovel much snow any more.  How do you know when you have overdone it?  Believe me, you will know!

Good luck on that 4-week VL test.  I bet you will do very well.

frijole