WBC Count

I wanted to ask about my white blood cell count.  This was my last cbc, prior to beginning treatment.  I began tx (180 pegasys 1xweek, 1000 riba daily) Friday.  These were drawn at different labs, and the labs had different cut off values, which I'll post.  My concern is about my white blood cell count and whether it might continue to drop?  Has anyone had experience with their wbc dropping during the beginning of tx and did it resolve itself or was neupogen (sp?) necessary.  If medication was necessary, was it an easy process to get it approved by the doctor, or?  Anyway, just asking for input here.  Thanks so much in advance for any info!

Blood Count 9/19 (done at the local hospital)

RBC: 3.57 L    (3.70  -  5.30)
HGB: 10.7 L    (11.5  -  15.3)
HCT: 33.3 L     (34.0  -  46.0)
(addressed these three above with epogen prior to beginning treatment)

WBC: 4.0 L      (4.1   -  10.3)
NEUTROPHILS: 45.1 L     (50.0  -  80.0)
NEUTRO COUNT: 1.82 L  (2.20  -  8.80)


This blood count is the latest cbc, drawn on 10-10-07 (sent to a lab in Birmingham)

RBC: 3.85      (3.80  -  5.10)
HGB: 12.7      (11.5  -  15.0)
HCT: 37.2       (34.0  -  44.0)

WBC: 3.1 L      (4.0   -  10.5)
NEUTROPHILS: 32.0 L     (40.0  -  74.0)
NEUTRO COUNT: 1.00 L  (1.82  -  7.80)
Lymphocytes: 58.0 H  (14  -  46)

*I will be continuing to draw weekly cbc's here in town, while my viral loads will be drawn by my hep doctor in Huntsville.  He plans to draw my next viral load right before my shot at the two week mark.  And Jim, the nurse was on vacation this week so I have to wait til Monday to get an answer to those ?'s of yours.  

[debnevada]

my white count waxed and waned.  it was 11 at the time treatment started (acute hep and postop is why), has been as high as 6 and as low as 2.3 but it has been around 4 for some time.

it went to 2.3 about week eight.

does that help?

deb

[alagirl]

It helps, but in some way it frightens me more that yours dropped so much at times.  I guess my fear is that since I'm so low at the very beginning of tx, I don't really have anywhere to drop.  I can't drop down two or three points because I'm already sitting at 3 after one week of tx, and my wbc hasn't been higher than 4 in the past couple of years.  Did they ever use any rescue meds for you or did they wait it out when it went to 2.3?  How long did it stay there?

[jmjm530]

Many hepatologists (including mine) don't pay much attention to WBC as a whole. What they do look at is the WBC fraction called Absolute Neutrophils (ANC), sometimes reversed on the blood report as Neutrophils, Abs.

As to the level you shoul intervene (Neupogen and/or Peg dose reduction), different medical teams have different takes. The old protocol was to intervene at ANC 1000. Some docs intervene at ANC 750. Some at ANC 500. My medical team rarely intervenes unless ANC gets down to 200-300 and stays for a bit.

One reason is that recent studies appear to show treatment induced low ANC does not make you more suspectible to infections, as the same ANC might if you weren't treating with these drugs. The other thing is that ANC can bounce around a lot. For example, my ANC dropped to 320, which means most docs would have intervened in some fashion. My doc said it would probably bounce back and to wait. Within two weeks my ANC was over 1000. Again, ANC -- unlike Hgb -- tends to bounce up and down.

BTW did you find out when you will be tested for viral load and what tests they will use, including their sensitivity?

Hope treatment is treating you relatively well.

-- Jim

[jmjm530]

Just read your last comment. So you're having a viral load test the day before your third shot? If so, that's excellent, and it would be called a week 2 viral load test. Do let me know the name of test and sensitivity when the nurse gets back.

As to ANC, it can be computed from the above, but I'm not sure how. On my lab report -- Quest -- it's already computed.

-- Jim

[geterdone]

After the first two weeks RBC was down to 3.4 I did not have a beginning cbc and at week 4 it had dropped to 2.7 and has stayed there since. WBC went from 4.19 and stayed at an average of 3.46. I am a 1b 48 weeker at week 31. So far so good on your stats.

jasper

[jmjm530]

It's possible that your "Neutrophil Count" of 1.00 is another way of saying your ANC is 1000. I am not 100% sure on this (not even 80% sure :) )so please do not take this in stone, but re-check with your doctor, or maybe someone else here will chime in.

[jmjm530]

Scratch that. I see your two labs giving different values, etc. Unless someone here has the answer (or formula) I suggest you call the doctor's office and find out what your ANC is. Your ANC value will be important to track as treatment progresses, although as stated, different doctors have different policies regarding intervention.

[geterdone]

Neutrophils Absolute, is this what your talking about jim? If so mine have been 1.5 and 1.3 for the last 2 checks.

jasper

[jmjm530]

Are you sure you're injecting the drugs into your own belly?
--------------
Just kidding. That's an excellent ANC for treatment. Like I said, mine dipped to 320 at one point. Using my scale, yours are 1500 and 1300 respectively. No problemas.

-- Jim

[alagirl]

yes, that is the test that says absolute next to the neutrophils, sorry, should have added that.  On 9-19 it was 1.82 with a parameter of (2.20 - 8.80) x 10^3uL, then on 10-10 it was 1.00 with a parameter of (1.8 - 7.8) x 10^3uL.  But it looks like Jasper has much the same reading so I'm probably fine.

I think that given what you're saying Jim, I don't need to panic unless the absolute neutrophils go down to .75 or .50

Also, I can't find it, but it seems like in another thread someone discussed this issue and said that sometimes docs start the neupogen too early when if they would just wait, the wbc rights itself a bit.  I can't remember who was discussing it though and can't find the thread, so I wanted to check it out.  By the way, I have an appt with a new hematologist set up in Huntsville a week from next Wednesday.  I have more than enough epogen to get me through until then and my doctor here in town is following my cbc.  I am taking extra epogen to keep my hgb up and it seems to be working.  If I hadn't taken your advice on that though, Jim, I am positive I would already be behind the ball.  Interesting research on the artificially lower wbc not causing as many infections or illnesses as a naturally occurring wbc.

And to answer your other question, yes, it will be right at the two week mark that I take my first test for viral load, and I take it the day before my third shot.  And I will definitely get back to you as to the sensitivity and which test it is - AND, at which weeks they do the follow-up tests.  Hey, I always do my homework.  lol

[FlGuy]

I agree with your perspect that absolute neutrophils were 1.82 (sometimes expressed as 1820) and on 10/10 1.0 (sometimes expressed as 1000) Not a surprising drop.  What is your shot night?  If the 10/10 (Wed) was the draw and Friday 10/5 was your shot night then the Peg was at about it's pek on a Wed.  If you are able, try to have cbc's and pcr's the day before shot day, or as far from the prior shot day as possible.

[geterdone]

lol... that’s why I keep on injecting in the belly. If, (only If), I knew then what I have learned now I would have ask, no demanded an opening blood count before the start.

Thanks!
jasper

[debnevada]

my wbc only stayed at 2.3 for a month or so  My neuts have always been okay.  always. never in the low range.

[alagirl]

flyGuy - on the first blood test results I posted up there, I had not yet begun treatment so I do have kind of a baseline.  My wbc has just always been a little low.  

The second results were after my first shot.  I did not begin treatment until this past Friday - that was the date of my first shot.  (In case I was being confusing, which happens a lot lol) I will take your advice on doing the cbc's on Thursdays.  Makes sense what you're saying about that being the best day to see the effect.

Jasper - I missed something,  What's the reason you always inject in the belly?

Deb/Jim, that's good to hear, makes me feel better.

[geterdone]

lol, ran out of leg spots to hit, too sore and no fat left, so now I take both in the belly.

jasper

[alagirl]

awwwww :( sorry.

I usually switch thighs and stomach with my procrit.  Was kind of planning to do the same with the pegasys.

[jmjm530]

Yes, you confused me with the two lab results. LOL.

Anyway, it now appears your ANC went from 1820(1.82) to 1000 (1.0).  And yes, I think I stated -- as have others -- that ANC bounces around a lot, and it may dip even more before it comes back up. Just as a heads up, don't be surprised if your doc gets alarmed even at ANC 750. I'll try and dig up a paper about the infection thing to show him. But as stated, a number of us here have gone below 500 without Neupogen.

That's great on the hemoglobin, although more telling will be your two-week test as the riba levels rise. It may turn out that you're not that sensitive to ribavirin, in which case you might discuss with your doctor raising your riba dose (gingerly) depending on what your viral response is at week 2. (Big response leave it alone, little viral response, maybe raise the riba IF tolerating it). But that's a bit ahead of the game.

As to the draws, for viral load tests, blood should be drawn the day before the injection or the day of the injection, but before the injection. CBCs are less important, but if Friday is your shot night, probably easy just to make Thursday your blood draw day. Given the fact that they will draw for viral load at week 2, hopefully you can convince them to draw for viral load weekly until you're UND. That will give you most accurate idea when you become UND, and give you the most advance notice and flexibility in terms of tweaking drug doses if necessary.

-- Jim

[susan400]

I dropped very low on my WBC and neuts, but never was offered neupogen until my treatment that I was on prior to the last one (where I was in the trial).  During the trial, my white blood cell and neut.'s continued to be a problem to the degree that if I hadn't been taken out of the trial because of the viral breakthrough, I wasn't bordering on being taken out of the trial because of the WBC/neut.'s issue.   Now, 12 weeks post treatment, my WBC and neut's are still below normal.  I have a lab order to get these rechecked.  I'm probably going to go next week sometime.  The trial site wants me to let them know if my report shows them still trending downward (these were ordered by my reg. Dr.).  If they stay the same, or come up, it's no need to come back up to see them, but if it's dropping any lower, they want me to come up there and see them.    Susan