White Blood cell count down. need advice/opinions.

I'm on pegasys and NM283.  I have had a pain in my lower left back this week.  At first I thought it was muscular but last night I realized it might be an organ.  The pain is radiating from the kidney area and itt occurs most often at night.  I do not have pain when urinating.

I decided that I needed to see a doctor about it so I called my study nurse.  She said my wbc is down to 1.9.  They want me to reduce my pegasys dose to 135 mg.  The doctor did not want me to come in about these issues and the nurse said it was not a big deal but I can't help but be concerned.

Is this why I'm so tired all the time?  Could the pain in my back be related to my WBC?  How can I naturally raise my WBC?

I made an appointment with my PCP but I haven't been to him in over a year.  He doesn't know about my diagnosis or treatment.  I'm scared.  The good news is that I am still clear of HCV.

[GrandOak]

WBC and ANC (Absolute Neutrophil Count) reflect state of your immune system.  I've used Neupogen to help boost them during tx, which works real quick (1 shot a day for 3 days has counts back to normal by day 4 from 1st shot).

I don't believe it results in tiredness, or at least not as much as RBC and Hgb being low, unless it is the effect of other bugs present which WBC is not able to kill as quickly.

Most tiredness result from RBC and Hgb being low because cells are not gettingthe oxygen and nutrients they need to function.

[Alady1620]

Thanks for the info.  I am on a study so I don't know if they will give me rescue drugs.  They want me to reduce my interferon dose but I really don't want to.  I am in week 41 or 42 of 48.  So close to the end!

[friole]

Like Oak I don't think the low WBC is making you tired, but your immune system is being suppressed and it may be affecting the tiredness .  My WBC got lower - down to 1.4 on treatment (ANC .4) even while I was taking Neupogen once a week.  What is your ANC?

I would try to keep the Peg up to the regular dose (how is he to know what you squirt out). Just an opinion there - but I am a risk taker.  I would try to get Neupogen too.
frijole

[GrandOak]

Peg-IFN is generally responsible for WBC reduction and Ribavirin attacks the RBC.

My WBC has been as low as 1.7, 1.6, and 1.4 when rescue med was prescribed.  It seems that the ANC is more important than the WBC as an indicator of your immune system, but WBC does figure into the ANC computation.  On all three lows for me, ANC was 700, or 0.7 as reflected on lab report.  From what I understand ANC of 500, or 0.5, is a point of greatest concern.

Have you discussed you concern on Peg-IFN reduction so close to end of tx with respect to you achieving SVR?  You may also want to discuss the issue of rescue med like Neupogen as well.  I seem to recall that VX950 studies would consider rescue meds after wk 12 of the study.  But each study follows a different set of rules in this regard.

[Alady1620]

Unfortunately, I do not know my ANC.  

So, you guys think that I shouldn't worry about this?  What happens if my WBC drops lower?  Could I get sicker?

I have two babies and I'm trying to decide if I need to find some childcare for them for the next week.  My husband will be home this weekend but it is unfair for him to have to work full time and then have to come home to babysit, clean and cook.

Am I overly concerned?

[MrsOckert]

I have/had the same pain you do, but mine radiated from the right kidney area.  It was never painful to urinate, however when I went to see my GP he found I had an e.coli infection.

I had emailed Dr. Cecil and he responded that skin, lung and urinary infections are common on TX and can be life threatening.

I suggest you see your GP just to rule out an infection in your bladder/kidney.  It might also be a kidney stone.  TX dehydrates us and we are more prone to kidney stones when dehydrated.

[Alady1620]

Thanks for your information.  I am already prone to kidney stones anyway.  I do think I have an infection.  Do you think I should wait until next Wednesday to be seen?  That was the earliest appt I could get with my trusted physician.

[Drarig]

After four weeks of tx, my wbc went down to about 1.2.  My GI immediately put me on a weekly shot of Neupogen.   He won't swear to it, but he tells me after conferring with other docs, patients that have low wbc while on interferon don't seem to experience the same serious probs from low whites such as those on chemotherapy for cancer, etc.  But he still wants me to take it weekly just to be on the safe side, because my counts do get down to critical levels & rarely go up to normal.  Even with levels that low, I really can't say I've experienced any major problems from it that I know of.  The only thing I noticed is that I get tiny cuts or cracks on my fingers and cuticles that hurt like he)) if I try to do something stupid (like skip a shot).  They don't heal until the day after I take my shot. Call it crazy, but that's what happens to me.  That's when I know my counts are really low - tiny cuts on fingers!  The Neupogen sx aren't bad for me, but I do have some fatigue the day after shot (I actually have more fatigue after my Neupogen shot than the Peg, go figure!) But it really isn't bad at all.  I plan on taking weekly shots for the rest of tx (doing 29 or 48 tonight!!!) I would definitely ask my doctor to consider Neupogen or something else rather than lower your tx dosages.    Best of luck to you!

[GrandOak]

Lower infection rate must be that spike balls don't like others moving in their hood, so any attempt draws em out of their liver crib to cap the intruders.

[GrandOak]

Have you eaten any spinach lately?  Latest news is of a serious e.coli contamination of bagged spinach leaves in Wisconsin, Connecticut, Idaho, Indiana, Michigan, New Mexico, Ohio, Oregon, and Utah. California is investigating a possible case there too.

As for WBC, I would suggest learning ANC as it seems to be more of a factor reflecting your immune system.  But like it's been said, low WBC does not seem to induce fatigue.  That more often is an sx of chemo induced anemia from reduced RBC, thanks to riba.

[MrsOckert]

If you don't feel that you could tolerate the pain until next Weds, you could go to one of those Urgent Care places.  They can probably get you in and do a UA.  If nothing else they should be able to prescribe some pain pills till you see your primary.

[sfbaygirl]

I agree with GrandOak. The ANC is what my dr. bases my need for neupogen. If it is below 1.00. It has been down to .4 and I didn't feel any difference. Apparently there is a study that shows that hep c patients don't get the infections as easily as cancer patients. I will try and find the link.

My WBC has been down to 1.4 and the dr. is not worried. I wouldn't reduce the peg if you can help it. What is your ANC?

[VanwssaGreeneyes]

I had the very same pain that lasted for 3weeks. And still does some.It was three weeks before my follow up appt. After trying many remedys, Bengay, warm bath limited amount of otc pain meds; I began to take a closer look at what I might be doing that could cause it.  What I finally figured out because of the sx I was spending a lot of time in of the heat of the day in bed.  I went to WM and bought a 4" mattress topper, used fewer pillows and it relieved most of the pain. I felt as if my guts all through my back were bruised especially in the soft tissue around my kidneys.  You are the first person to mention the sx so I thought it was just me. Van

[Alady1620]

I convinced the nurse at my PCP's office to squeeze me in to see the doctor on Friday afternoon.  My counts are up to 2.9 which is better but not normal.  He gave me some antibiotics for a sinus infection and said that my urine was normal.  He also gave me some muscle relaxers bc he thought the pain close to my kidney is muscular.  

Thanks for all your input and advice.  I am a type A personality and I have been very stressed about my health.  The news of my wbc about threw me over the edge.  I am doing much, much better today.

I don't think they'll give me rescue drugs on this study but I only have 6 more shots to go so, hopefully, I can make it to the end.  I called the study nurse to run my medicine by her and she said I could take the entire dose of pegasys.  That was a relief too.  Thanks again everybody.