low neutraphils, skip weekly interferon?

[kciav]

Hi all,
Last week my son's neutraphils went down to .44, so the nurse called and said to skip last Friday's interferon shot.  When I asked about the extra shot to help boost the white cells instead I was told it takes too long and that is what the Dr's told her to skip the weekly interferon.  My son is on his 36th week.  I am worried about skipping the whole week, we are to retest levels tomorrow, Wednesday.  He did have a RVR at week 4, he had <10, but detected and has been undected since.  I am worried about SVR now.  The nurse also said they would be reducing this week to 1/2 dose even if the neutrophils go up, if it doesn't go up will skip again.  

Help!  Does this sound OK or should we be pushing to get it going sooner?

[frijole]

Neupogen does act quickly and can be done in the doctor's office or with a prescription, at home.   Although a low ANC of 400 is really bad for a cancer patient, there are studies that show a Hep C patient can withstand a low ANC and not get a lot of infections (which is the worry).  If possible, can you get a referral to a hemotologist (blood specialist)?  ANC does fluctuate a lot and can go up.  How often is your son getting his bloodwork done?  

If it were me, I would be hesitant to dose reduce.
frijole

[kciav]

Hi!
Thanks for the reassurance!  Hope you are feeling good.

I didn't get all his numbers at the time she called me since I was driving.  Guess I didn't expect anything out of ordinary, since all other bloodwork has been OK, and never needed to stop any treatment before.  Pretty sure his platelets are good, they've never been low at all.

He is taking the full riba, hopefully he will get going on the interferon soon.  He does feel a bit better physically this week but mentally seems a little more challenging.

Maybe I will ask for the neulasta or neupogen again this week if the numbers are not going up.

Take care...

[newleaf09]

It's okay, since he has been cleared so long, but I always think it's better to boost the ANC with the Neulasta or Neupogen.  I think the nurse has mixed up the response time for Procrit for boosting hgb with the response time for the neulasta or neupogen, which are nearly instantaneous in someone who responds to them.  

I think there may be another factor that the nurse didn't mention, which is low platelets.  If both low neutrophils and low platelets are the issue, skipping one interferon shot and starting back with reduced interferon is the proper plan.  A week off will bring up the neuts and platelets a good bit and reduced interferon will help slow down beating them back down.  Just make sure his riba stays at full dose, if possible.

It would be a lot less worrisome if you could get ALL of the facts over the phone but it's pretty hard to get them out of health professionals.  I cleared early and neut and platelet levels kept staying low until I got to the point where I had to skip and then stop all meds ans restart on dramatically reduced interferon lasting until the end.  When the next PCR's still came back UD, I was able to throttle down the worrying.