Which numbers to use on ANC?

[hcvJames]

There are two sets of Seg & Band Neutrophils numbers on my CBC printout.
One set it expressed in units of %, always a whole number.
The other set is call ABS Seg & Band. Unit's of 10^3/ul. Always contains a fraction, 1.nn or .nn.

[hcvJames]

no your calc is right. the numbers you used are wrong. 15.5 - 45/46%. the chart is an older cbc, i don't have a hardcopy of the current one.

[frijole]

I guess that my calc is wrong based on what you said -- I used your WBC of 15.5 plus the info on your chart, Neutrofils, 25, bands, 8, which is from another CBC

I think I would have to see your actual CBC to believe your ANC calculation.  I find it hard to believe that your neutrophils and neutrophils forming ar 91% of the total white blood cells in your body.   What happened to your monocytes and your lymphocytes?

What are all the numbers that compose the 100% of white blood cells?  I suppose if you did the CBC right after a shot of neupogen your blood could have been manufacturing a lot of neutrophils but those bands seem way too high

[frijole]

Your ANC is 5115 which is in range , the range being 2000 - 8000

You use the percents of neutrofils and bands.  A lot of times the CBC doesn't even show bands which are baby neutrofils (neutrofils in formation.

I have about 3 absolute neutrifil calculator websites and this one shows pretty clearly that it is the percents that are used in the calculation

http://www.globalrph.com/anc.htm

but this one seems a bit more accuate to me

http://www.freekinetics.com/anc_calc.htm

[hcvJames]

FWIW on my MedHelp home page there's a tab for "charts." In it is a cropped out section of a CBC taken on 05/03/10. It's not the CBC we're taking about. But it does show the format of the two sets of neutrophil counts. I didn't get a printout of the current CBC just copied the numbers down. It will be a week or more before I can get back to the hospital to get a hard copy. By then no one will care anymore ... ha, no one does now. I'm beating a dead horse. I get mild OCD on stuff like this. Sigh.  I just wanted to identify any possible problems and find work arounds before the next clinic visit.

spectda: 14105 ANC isn't so bad, I've had, at least 23 before. It may have been double that at one point. Anyway WBC/ANC slams down to cutoff in a matter of weeks and I don't have access to treatment that allows close monitoring. I appreciate your comments on Neup stimulating cancer cells. Does it help that I don't have cancer? (not being flip.) Thank you.

[spectda]

James if your anc is 15.5 it "way" to high especially if it is from neupogen. You need to adjust your dose until it is at about 1000 which is a safe level. It's not suppose to be in the normal range when induced by neupogen, just in the low safe range. I discussed it with my doc when I was concerned that it went from 280 (.28) to 6500 (6.50) after many weeks of neupogen. last blood mine stabilized at 3500 after reduced dosage, still high but not crazy high. Neupogen can stimulate cancer cell growth, you don't want more then you need.

http://www.pbm.va.gov/Clinical%20Guidance/Criteria%20For%20Use/GCSF%20Criteria%20for%20Use%20for%20Hepatitis%20C,%20Criteria%20for%20Use.pdf

"Titrate filgrastim dose to achieve ANC 500-1000/mm3.
 Check nadir ANC just prior to the next dose to evaluate response every 1-2 weeks until stable
 If ANC shows no increase or continues to decrease after at least 1 week of filgrastim, then further
reduce or discontinue peginterferon and titrate filgrastim as above.
o Investigate other potential cause for neutropenia (e.g. myelodysplasia)
 If ANC >1000/mm3, stop filgrastim."




in cancer patients they don't want them to go above 10,000. but they bring them to that level so they bring them to that level before administering chemo because it is counter productive to destroying the cancer cells, and they stop the neupogen during the chemo infusions.

http://www.rxlist.com/neupogen-drug.htm

"in cancer patients receiving NEUPOGEN® as an adjunct to myelosuppressive chemotherapy‚ it is recommended‚ to avoid the potential risks of excessive leukocytosis‚ that NEUPOGEN® therapy be discontinued if the ANC surpasses 10‚000/mm3 after the chemotherapy-induced ANC nadir has occurred. Doses of NEUPOGEN® that increase the ANC beyond 10‚000/mm3 may not result in any additional clinical benefit."

The maximum tolerated dose of NEUPOGEN® has not been determined. Efficacy was demonstrated at doses of 4 to 8 mcg/kg/day in the phase 3 study of nonmyeloablative chemotherapy. Patients in the BMT studies received up to 138 mcg/kg/day without toxic effects‚ although there was a flattening of the dose response curve above daily doses of greater than 10 mcg/kg/day.

- Dave

[Trinity4]

James,

I'm looking at my bloodwork from 2/10/10 and here's how my ANC is figured

WBC was 4.7  (In range 3.8 - 10.8 Thousand/uL)
Neutrophils was 64.8   (In range 47 - 74.6)

WBC 4.7 X 64.8 = 3046  (In range 1500 - 7800 cells/uL)

Just mulitiply the WBC x the Neutrophils and that's your ANC

Trinity  

[portann]

That was me, James. I don't know anything about flipping from neutropenia to neutrophilia but hope someone else can help. What does your doc say?

I', curious to know what's up with this, as bands are often negligible. Even if they're being fired up by the rescue drug, I had no idea they could reach 46% just from the drug.

Hope someone more knowledgeable weighs in but please let me know how your doc interprets this. How soon will you be seeing him and can you call him to make sure he's on top of this?

Susan

[hcvJames]

So the number to use is %. Which I did, but someone questioned whether the right numbers were used. Because the % seg & band were 45 & 46 % with WBC @ 15.5 (ANC 14105).

[Trinity4]

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