White Cell Drop Off

Hi All, I just had the wk 5 blood work done. So far my white cells are really down. I'm caught up in the ins. jungle waiting approval of the "other shot" in the mean time my Dr. says to not take as much of the pegasys. I feel that is compromising my treatment. Am I off base here or is there something I can do to help move past this slump.

Thanks, Cityman

[jmjm530]

Yes, reducing your pegasys at week 5 can potentially compromise your treatment to some degree.

What is your ANC (absolute neutrophils)? ANC, the WBC fraction, is more  important than WBC itself in terms of dictating whether the peg has to be reduced or a helper drug like Neupogen should be used. The latter -- using a helper drug -- is preferable in the sense that you then don't need a dose reduction.

However, if your ANC isn't below 500, then a lot of doctors will not reduce the Peg or even prescribe Neupogen. My doc, let my ANC drop to 320, and still let me continue on full meds without Neupogen. On the other hand, some docs still go by guidelines that suggest reducing Peg earlier, like when ANC hits 1000.

The other point is that ANC has a tendency to go up and down. One week low, the next week high.

Of course, you should follow your docs advice, but you should also discuss all these issue with him. Also, have you had a week 4 viral load test yet? If not, I'd ask for a VL test now, and have blood drawn the day before your next injecion. That way you can see if the meds are working or not.

-- Jim

[cityman8382]

I wish I was more in tune with all of the med stuff. I have to admit I think I'm still in denial and wishing it would all just go away. The idea of backing off instead of doubling up is hard for me to grasp. I want get busy and the doc says hold on. How is this going to work? It's pretty early in the game to be sitting on our hands here don't you think?

Cityman

[jmjm530]

It's difficult, but sometimes you have to be your own advocate and negotiate with your doctor. First, find out your ANC. If it isn't below 500, make the argument that it's not low  enough for intervention. If it is below 500, make the argument that you would rather go on Neupogen and could he please push the insurance process along -- or maybe you just pay for the first shot or two and then get reimbursed by your insurance company.

If you want a little ammo, you might want to print out this study that suggests that interferon induced neupotenia (low ANC) is not associated with higher infection rates.
http://tinyurl.com/26tbmt

Good luck and hope your doc lets you stay on full-dose meds,

-- Jim

[cityman8382]

Thanks for your time I will do just that.

Cityman

[wyntre9]

I've been on TX for 56 weeks with 16 more to go.

During the first month, my ANC dropped to .8 and WbC went down to 1 or so.

My Dr.  immediately put me on Neupogen.  ANC/WBC have never gotten back to more than 50% of original levels but the meds do seem to have stopped the decrease and has, i presume, allowed me to stay on TX.

I take the neupogen every two weeks.

I agree with Jim that you should try NOT to decrease the peg/riba doses as it could negatively impact your treatment.

wyntre

[merryBe]

ok now I'm confused again. my WBC is 4.3 and nothings been said to me

but the only numbers for neutrophilis shoes 57.8%..midrange

and for neutrophili Abs it shows  2.6   ...I can't find an ANC number anywhere??
what am I missing???

[wyntre9]

Your count of 4.3 for WBC is within normal range, according to the lab test I get, which cites a reference of 4 - 10.5.

wyn

[PRINCESS5121]

your WBC is good.norm is 4.0-11.0.mine was 4.0 prior to treatment.im day 33 into treatment , and last week WBC went down to 2.1.dr reduced 5th shot to 135mcg,just one shot,now last night 180mcg as usaul.this week WBC went up a bit to 2.5... just did 6th shot last night,and on 400 my riba 2 x day.my RBC is still good, but my doc still didnt check me for my ANC yet either.i go see him 1-10 and will demand my vital load and ANC test.no rescue drugs given to me yrt.my neuts were 33-38 % both last 2 tests............now this morning i wake up with face feeling slightly swollen,and hands and fingers too.wonder whatthats about.did 6th shot 11 hours ago...feelin a little achy,but swollen hands and eys are is new to me..............any one experience that after injecton ?

[cityman8382]

Thats encouraging to hear that the neupogen has been such a help to you. My problem is I am stuck in the ins. merry go round. I may have to fork out the money like Jim says till they quit bickering. You feel slow and drained already. The last thing you need is to deal with them. This is from every angle a challenge. Fourty some more weeks to go and it's a done deal I hope.
Thanks to all,

Cityman

[jmjm530]

Just like to add to my previous post re Neupogen intervention. As stated, my medical team didn't prescribe Neupogen (or dose reduce the peg) even when my ANC was around 300.

In fact, the NP told me that they rarely use Neupogen in their practice. And this is a huge practice where the liver specialist in charge runs multi-trials, writes papers, and lectures and teaches on HCV and treatment. Of course, different doctors have different approaches, but just wanted to give you at least one take. Personally, what I've seen from reading here, is that most inexperienced doctors prescribe Neupogen too soon (or worse they dose reduce the Peg instead) yet these same doctors prescribe Procrit too late. Never figured that one out.

Point I guess is that while you should get the Neupogen RX ready to be cashed -- out of your pocket or not -- first check your ANC and make sure you really even need the Neupogen. And if it's not below 500, maybe sit down with the doctor to discuss.

FWIW, two weeks after my ANC was around 300, it jumped up to over 1000. And that was without Neupogen and without a reduction in Peg. My NP actually told me it probably would do that. She happened to be right.

-- Jim

[merryBe]

ok so the ANC jumps around on it's own...and this is why the test isn't part of my CBC?

I found one formula for figuring it out yourself on a cancer site, from your other blood work..but I was too brain dead to even add last night.
Think I'll just ask tomorrow.
thanks for the tip.

[PRINCESS5121]

i think you add your neuts% and times it by 12%............dont hold me to this,i overheard my dr trying to figure it out with his calculator when on phone with me........you dont know anyone who has experienced swollen hands during tx have you.im worried,now tonight i got 2 episodes of irregular heart beats which i have been on meds for 25 yrs for,but had none the 33 days ive been treating so far.sure hope this tx isnt effecting my heart.and suggestions anyone ?