low anc on week 12

[cjsam]

Ok so here's the deal, I get a blood test two days before my shot.  Last week the neutophils and wbcs were low so the doc had me delay my shot a couple days (I usually take it on friday, he had me wait till monday), I got a blood test on Monday and they went up a bit, so the doc let me take the shot (that was shot #11).

I just got my lab results from this week back, and am a bit (ok ALOT) unsettled.  The # of neutrophils is 0.67, bands%3, segs%23, wbcs 2.59K/uL.  If I correctly fig out the ANC it is 673.  I have a feeling the doc may delay the shot again, he hasn't done it yet though.  I am unsure why neupogen isn't an option as I have had to delay my shot on two different occasions b/c of low wbc/neutrophils.  The doc tried to explain to me he hasn't used it yet, because my wbcs are wavering, they keep coming up eventually, and don't stay down.  I am not satisfied with this answer because I may have to delay my shot a third time because of this issue.  And I know how critical the first twelve weeks are.  Plus I am suppose to go for my 12wk viral load in one week (haven't done a viral load yet) to see if I continue treatment or not.

What do you guys think about the situation?  Has anyone had something similar?  It may just be I am stubborn and don't like to hear the word "no" as in "no you can't take your shot today" because once I make up my mind about something I like to follow through, however I realize treatment isn't like that.

[Trinity4]

Ok, positive thinking here.  You ARE going to be UND at the 12 wk PCR.

Having said that but keeping it real in the event you are not UND you can continue on with treatment in hopes you will become UND shortly there after.  Those of us who are not UND by week 12 are considered slow responders and many hepatolgists advise extending treatment to 72 weeks for the best chance at SVR.

If you are not UND by 24 weeks treatment is discontinued because your immune system is not responding effectively to the interferon.
Also, if you are not UND by 12 wks you have the option of discontinuing treatment and waiting for the PI's (liver histology permitting) which should be out sometime in 2011.  With current SOC geno 1's have around a 45 percent chance at SVR and slow responders even less.  The PI's give us around a 70 percent chance of SVR and even though we've treated already with interferon we do not develop a resistance to it like those who have previously treated with a PI and failed.

Talk to your doctor about your options and especially about prescribing Neupogen.

Good Luck and hope to see a UND post
Trin

[cjsam]

Thanks alot Trinity, seriously you guys and your support mean so much.  I am made an appointment to see a hepatologist for this coming monday.  It worries me too and I feel that the doctor is potentially being more conservative than need be, however I am not a doctor, so I figure who better to ask than, well, a doctor about this situation.  I figure even if I am UND at week 12 I will try again, as my shots have been moved around 3 times already because of a low WBC/Neutrophil count, and I feel that if I am UND I may have a better chance if preventative measures are in place if I try treatment again.  Speaking of which, and I acutally just posted this question separatly, do you know, if I am not UND how long I should wait between treatments, because I'll be damned if I give up now.  (Yeah I'm stubborn)

[Trinity4]

Damn cj, your doctor should have been proactive and ordered the Neup because the helper drugs are there so we don't have to skip shots.  That really and truly erks me.

I don't know what your ANC is but you really shouldn't miss shots and I surely do hope you ride that doctors a-s-s until he prescribes the Neupogen.  If your ANC hasn't rebounded after tomorrow's test you won't be able to take your shot on Friday.
That is just wrong and even if you do get to take your shot Friday, what about the following weeks?  

Please talk to your doctor and if delaying or skipping shots is his idea of dealing with low ANC instead of prescribing  Neupogen, find another doctor.  I'm not saying you won't be UND at the 12 wk PCR but the way he's calling the shots and I mean literally calling the shots he is not giving you every opportunity to acheive SVR.

This really worries me cj and I'll keep my fingers crossed things get resolved sooner rather than later.

Trin

[cjsam]

Thanks for your advice.  I was told to skip my shot this week (monday) I go for blood work tomorrow and if all is good can take my shot (shot 12) friday.  A little bit nervous about my und now.  Still no neupogen.

[Trinity4]

Most hepatologists don't get concerned until the ANC drops below 500 and some allow the patient to treat with lower numbers and no Neupogen.  I mentioned on another thread that the threshold varies with different doctors.  

I understand your concern about having to delay your shots and the ANC is low but not critical YET.  Having to delay shots shouldn't be standard procedure with treatment and the pattern may be it will not rebound enough to put your doctor in his comfort zone which will cause delay once again.  

Talk with your doctor and make him aware of your concerns.  Be assertive and tell him you are not comfortable with delaying shots and would like him to prescribe the Neupogen in the event it is needed.  That way delays or even dose reduction will not be necessary.  Neupogen is fast acting so by the next day the ANC should be climbing back up even if it hits the 500 or below mark and you can continue treatment without interuption.

Speaking from my experience only, once my ANC hit the 600 mark it continued to drop and did not climb back up.  I was dose reduced twice in the first 12 weeks and my doctor did not prescribe Neupogen until I pitched a fit.  After that, I was on Neupogen for the better part of my treatment.  

Trinity