White blood count down

Hey everyone,  Its sally.  I went to dr. yesterday and hade the PCR test done.  My white blood count is now really low.  Dr said to come back in 2 weeks and if blood work shows the count is not improving we will have to re-evaluate my dosage.  Also they will call me on the results of the PCR test.  Friday will be my 5th shot.  Suddenly I'm so tired and scared.  Another dr has me on Xanex and this is seeming to help.  I don't take them everyday but my rage is getting out of control and sometime I need to just chill out.   Hep dr said te xanex might not be a good idea.  Any thoughts?? What exacly does the low white blood cell count mean?
Thanks,
S

[meakea]

A low white blood cell count is to be expected while on treatment.  The interferon injection is responsible for that.  The thing is that the docs don't want it to go "too low."  

It seems that your doc is on top of things and is watching it.  If your doc decides he needs to re-evaluate your dosage, ask him/her about a shot of Neupogen instead of reducing your meds.

Many people on TX have had their white blood cell count go too low and they have had to take an additional injection called Neupogen.  Some docs do it that way instead of reducing the treatment meds.

Be sure to ask about it to see what his/her opinion is on it.

[Bill1954]

Hi Sally,

Are you treating with a GI doc, or a hepatologist?

Our white cell count is best viewed through the absolute neutrofil count (ANC); these are specialized cells that fight bacterial infections. If this count falls below .500 or so, doctors often intervene so we don’t become ill, and have to stop treatment from infections. Some doctors will allow the ANC to drop to .30 or so; depending on the patient.

There are two methods to deal with this; one is to reduce the interferon dose to allow ANC to rebound; the other is to introduce ‘Neupogen’, an injectable drug that promotes white cell production.  The later is preferable; it allows us to remain on full dose interferon to give us our best shot at success with HCV.

Ask your doctor if he feels Neupogen is appropriate for you; it’s also known generically as ‘filgrastim’; a GCSF drug.

Bill

[newleaf09]

Filgrastim is also prescribed as pegfilgrastim (called Neulasta).  My doctor used the 500 neutrophill count as a cut-off, so every time I got down around 500 I used Neulasta.  The interferon drops neutrophils and platelets.  Some people can do okay with low neutrophils but just as many end up with kidney and sinus infections, etc.,  that make you even more miserable.  You may want to start the approval process with your insurance company now, to avoid any delay if you need to add the rescue drug at your next visit.  It involves some faxing back & forth between the insurance company and the doctor's office.  If blood counts get way low, some doctors may stop the treatment until they come back up, and you don't want that.

Right now, the low neutrophils can be remedied with filgrastim (Neupogen, Neulasta), but nothing is prescribed for low platelets (whites involved in clotting) except for reducing the interferon.  There is a drug (eltrombopag) that stimulates platelet formation but the FDA has not approved it to go with the HCV treament drugs, so insurance may not cover it.  

It is always better to use the rescue drugs instead of reducing the peginterferon or riba, especially if you have not cleared yet.  My neutrophils and platelets dropped after I cleared the virus, so I was on reduced interferon for 2/3 of TX.  Made me anxious but was not a problem for me staying clear.  You may as well line up Procrit (to increase red blood cell formation) with the insurance company while you are at it.  Only riba reduction can raise hemoglobin levels and studies have shown that reducing riba may reduce your odds of clearing and staying clear.