low ANC

I'm in week 7 of treatment.
At baseline my neutrophils count ANC (NE) was 6,400.
At week 2 it dropped to 1,900. Which was still in the normal range >1,800.
At week 4 it was 1,600. It was a drop of 300 and my GI predicted that the next drop will be even smaller and that at some point ANC would reach a plateau.
At week 6, however, the drop was of additional whooping 600 down to 1,000.
I faxed the results to my GI and he called me and said to continue with full dose because I'm still above 750. Only when ANC<750 you reduce dose to 135mcg. And when ANC<500 you stop treatment.

Formally, he's right and obviously he's reading to me the Pegasys Hematological Dose Modification Guidelines (Table 6).

But he's not considering the dynamics of the change

[jmjm530]

1000 is a very respectible ANC, regardless of drop. Also, keep in mind that ANC, unlike Hemoglobin (hgb) is not as linear in nature. My ANC was 500 one week, 800 another, and then back down to 500. While some docs, lower dose at ANC 750, many (including mine) don't get concerned until it hits around 200-300. My ANC went as low as 320 and they just told me they would keep watching it. NP in fact said they rarely use Neupogen in their practice and these folks treat a very large population of Hep C patients. In any event, two weeks after my ANC was 320, it was back up over 1000 again. Follow the bouncing ANC :)

-- Jim

[jmjm530]

I probably should have added that whatever cutoff point your doctor uses, many liver specialists now prefer to use Neupogen rather than reducing the dose of interferon. Reducing your peg can also reduce your chance of SVR. Neupogen is a very fast acting drug so therefore, unlike Hemoglobin, one can intervene very close to the cut-off point. If your doctor doesn't believe in rescue drugs like Neupogen and Procrit, you might want to consult with a liver specialist (hepatologist) who does. You really want to give yourelf the best chance at SVR.

-- Jim

[sfbaygirl]

Why don't the use Neupogen? Does it have sx? My doc just gave me a shot, I feel like ****. Not sure if it is regular sx or the neupogen (neulasta).

Also why do my numbers read 3.4 down to .7 like this? How does it get into the thousands?

Thanks for the help.

[jmjm530]

You know, I never asked exactly why they hardly ever use Neupogen and I probably should of. I just know that they rarely do because they feel it's not necessary unless ANC drops to 200-300.

There also have been some studies showing that interferon induced low blood cells (neupogeia sp?) is not as serious regarding infections as non-interferon induced low whites.

Regarding your numbers, I'm guess it's a matter of what units it's expressed in. I assume that your result of "3.4" would be 3,400 using the units my lab reports, and .7 would be 700. Using your calibration system, it appears my doc would not interve with Nupogen until your ANC drops to .2 to .3. However, from what I've read here, most doctors seem to intervene earlier, say at .5 or .75.

-- Jim

[Valtod]

Jim, thank you very, very much! I guess my depression, anxiety and over-rationalizing put me into almost full paralysis of the will. Your words  really gave me back the courage to continue with the full dose.

[Valtod]

Absolute neutrophil count (ANC): the real number of white blood cells (WBCs) that are neutrophils. It's usually in thousands per mm³ (K/mm³) units. So 500/mm³ and 0.5 K/mm³ is the same amount.

The ANC is not measured directly. It is derived by multiplying the WBC count times the percent of neutrophils (NE%) in the differential WBC count. That is: ANC = NE% x WBC

For example, in my case:
WBC = 3.3 K/uL and NE% = 31.9 %, so ANC = 31.9 x 3.3 = 1.052 K/mm³ or 1,052/mm³

Some labs list this number as NE#, others as ANC, or don't even list it directly at all (assuming you can always easily calculate it).

[sfbaygirl]

Now that's a picture! I see this goofy monkey doing some funky dance. I'm sure your kids get a kick out of it!  I feel lousy today, I think from Neulasta, nothing like a funky monkey, though! Just woke up from another nap today.

Thanks for the explaination about the differences. It helps a lot.

Now those numbers and crazy letters...remember I am not even allowed to write checks anymore!

[Valtod]

Also, Microliter: µL = uL = mm³

[Valtod]

Jim, I have a similar question: are there any diet or lifestyle changes that can increase the neutrophil count?

[jmjm530]

I don't know of any and would definitely check with your doctor before taking something other than prescribed to raise your WBC or
ANC. In fact, you should run any supplement, vitamin, herb or significant diet change, etc.,  by your doctor during treatment. MY NP explained to me that the bouncing around of ANC often had a lot to do with the bodies reaction to fighting infection -- and I certainly had my share during treatment, being on one antibiotic or another almost half the time :)

-- Jim

[GoofyDad]

Platelets and WBC/Neutrophils are different. Neuts are specialized white blood cells. Platelets are resopnsible for clotting and Neuts fight bacterial infections. Neumega is a growth drug for platelets, but is rarely used in Hep C treatment. Not sure why - just nasty I guess.

Wheat grass juice is suposed to raise WBC counts, I tried it and it and it didn't seem to do anything but almost make me hurl so I stopped. Sometimes Neupogen gave me the funky monkey, but most often it was OK.

[sfbaygirl]

These numbers always confuse me.  My WBC is 1.7 and Abs neutrifils is .7, doc wanted to cut tx drugs.

I can't understand why, if they have a drug like Neulasta that will correct it. Especially since I haven't had my 12 week PCR.  Hopefully they will rise this week.

I am also confused as to what the difference is in WBC, neuts, platelets etc.  I have read some people have low platelets (mine are 117) that are 40 more or less, and they want to stop tx. Why not the neulasta?  

Are low platelets different that low neuts?  Is there anything to raise platelets besides beets and transfusions?

[ifx23]

I missed my 5th shot of interferon due to my neuts dropping to .4. I started neupogen shots twice a week and the ANC came back up very fast and actually got too high so we went to once one week and then twice the next until about mid treatment when by then I needed it twice a week and continued that until the end of tx. A good day for me was around .7 to 1.2 :)  Did neup. Tuesdays and Thursdays and Peg. on Fridays as the neup. seemed to cause a bit more joint pain if I did it on the same day as the peg. but once I started it on the other days there were really no prominent sides from it. Did my last shot of neupogen the day before my last interferon shot. Did 49 weeks to make up for the missed 5th shot. 2 month post followup was a little low on whites but almost back to normal. 6 month post tx pcr the end of this month :) Good luck with the remainder of your tx :)