low wht. blood cell count with combo treatment

[asking-for-nancy]

Posted by asking for nancy on May 24, 1999 at 21:46:04
My friend had a blood test done last week, and now her white blood cell count and neutrophil (?) counts are down.  The doctor has cut the Rebetol portion of her combo treatment in half. She's been on the combo treatment for about five weeks now.  How does this effect her?  Is this a common situation?  Is there any other drug she could be using?  If infact her white blood cells are down, need she worry about other infections?  Thank you for responding to the previous questions I've posted on her behalf, obviously, she doesn't have access to the internet.  

Posted by HFHSM.D.-D.M. on May 28, 1999 at 08:37:33

Dear asking for nancy:
I appreciate your question.  Certainly, a low white count is a common side effect with combination therapy so I appreciate the opportunity to make some comments on it.  
Combination therapy with interferon and ribavirin commonly drives down the white count and especially a certain type of white cell called neutrophils that are important in fighting bacterial infections.  It is important for people to appreciate that it is the interferon part of the treatment that really drives down the white count.  It is possible that the Rebetol (ribavirin) part contributes but we know that when we use interferon alone, we see the same problem.  As a result, if the white count or the neutrophil count gets to be very low, we typically adjust down the interferon dose and not the Rebetol dose.
There are a couple of additional comments.  First, with time and experience, we have to come to appreciate that our hepatitis C patients can tolerate a lower white count on treatment than we originally felt comfortable with.  If we are able to keep the neutrophil count (ANC) above 750, patients do not typically develop infections.  Secondly, we can sometimes use a second drug called GM-CSF or Neupogen to keep up the white count.  Neupogen is a drug that is used primarily for cancer patients receiving chemotherapy.  It is effective in getting the bone marrow to make more white cells.  Like interferon, it has to be injected.
I hope this information is helpful to you.  I would invite you to contact us again with additional concerns or questions.   At Henry Ford, we have an active group of liver specialists with a strong interest in hepatitis C.   The direct number to our Liver Clinic is [phone].
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question physician when you have a question pertaining to your health.