what do the numbers mean???

my test results on the PCR test was 9850 what does this mean if you can help out on this one please do. a nurse told me that it would take 6 months to a year for me to even get on the waiting list for this. is this true thank you again trisha

[jmjm530]

Hi Baby,

Did you find out your genotype yet? I forgot, but have you had a biopsy or not? What are your enzymes.

If the "9850" has IU/ml next to it, as in 9850 IU/ml, than your viral low is extremely low.

If you don't have your tests handy, I strongly suggest you call the doctor office and get copies of all your blood tests. The more information you have, the better we can try and guide you.

What is this "waiting list" you are talking about? Is it a wait list to start treatment? Do you have other options to treat elsewhere or is this an insurance issue?

-- Jim

[Tonyz]

Welcome....................



Do you have a copy of the test? I suggest that you make sure that you get copies of all the tests done in you fight with Hep-C.

The number you posted. I could only take a guess at it. It would tell me that you have a very low Viral load. But more information is really needed from the test report to be sure.

Below is chart of what the numbers mean.


Viral Load Chart
  Viral Load in eq/ml
Classification  Remarks

below 200.000 very low below detection limit of bDNA test

200,000-1,000,000 low
  
1,000,000-5,000,000 medium  average viral load at 3,200,000 eq/ml

5,000,000-25,000,000 high

above 25,000,000 very high
  



Expressed in IU, the average viral load is at 1 Million IU/ml. All these classifications of viral load of course make sense only for patients that are not being treated against HCV.

                   Blessings

                     TonyZ

[PasoPerson]

Please excuse the cross-post, but it IS about numbers and I didn't want to waste a new thread.  My doctor allowed me to have a 4-week PCR.  

(I see lots of folks very unhappy with their doctors.  I have to tell you that Shands Teaching Hospital, a part of the University of Florida in Gainesville, has THE BEST doctors around.  I am so thankful to be close enough to take advantage of this Hospital.)

7/21/05 baseline was 1,300,000*
8/25/05 began treatment
9/22/05 4-week PCR was 427,400

I have two more months to get this down to 13,000 (2-log drop).  Comments, please?

*I had other viral loads done, but that's the one my doctor chose.  My others were taken 5/9 to 5/18 and ranged widely: 1,960,000 - 8,980,000 - 14,400,000.

- Carolyn

[jmjm530]

Glad you got your week 4 PCR. Sounds like you have a team you can work with. I think they're right to err on the side of caution and use the 1.3 million PCR.

Ideally, you would have wanted a 90% drop in the first month. Can't find my calculator :) but I think you should have been looking for 130,000 IU/ml.

I forgot your stats -- genotype, biopsy stage, age, etc. -- and what drugs and doses you're on -- but if it makes sense to be agressive, I'd speak to my doctors right away about upping the doses of either the Peg and/or ribavirin. This approach should be followed with weekly PCR's until you are non-detectible. Not every teaching hospital will do this, but many will. And often you really have to ask because it's not standard protocol. Just keep in mind that more drugs can mean more side effects.

-- Jim

[jmjm530]

To finish my last thought...

and more side effects can lead to a greater chance of patient non-compliance. So, part of the decision has to be how strong you feel now and how much more you think you can take. All that, and how much damage does your liver currently have. If you're a stage 0 or 1, you may not want to fight as agressively as a 3 or 4 might. But then again, it's really an individual decision.

[cuteus]

my initial VL was 376,00, 3 months prior to tx, who knows what it was right before starting, then it was 125,000 at wk 4, and still detectable at wk 12 with 5972 or so. It used to be that most drs used to call people like me EVR, even if VL was present. Now I see that many are calling detectables at wk 12, slow responders, but many are still calling them EVRs. I chose to think of me as slow responder and extend my tx for my best shot at SVR. The way the meds made me feel was not pleasant enough for me to want to do this tx again. So, one shot, my best shot. It worked for me.
Hopefully you will be undetectable at wk 12, try to have them change your dosages as suggested.

[go-girl]

What exactly is a viral load, does higher mean more severe case of hep-c? I get my PCR results in 2 weeks or so, a week before I start tx, so I take it thats good as I will know when I get the next one if treatment is helping, is that correct? thanx in advance

[GoofyDad]

Well as long as we're jumping on this thread with new numbers, please allow me to throw my hat into the ring. I had my 1st 2/wks CBC drawn today & the nurse emailed that doc wants to start Neupogen to support WBCs and go to weekly CBCs. I didn't get my copy from the lab yet, so I don't know today's numbers. I went into tx low, with 3.7 WBC and 36 Neutrophils.

I'm bummed to be going to Nuepogen so soon. Is that like procit where early intervention can short-circuit your body's natural response? Or do folks sometimes get a couple boosts, and get back on track from there? I guess my body might be responding but the WBC's it's making are backing up into the old spleen,  as I'm an early stage 4. But if that's the case, creating more with Neupogen wouldn't help alot, so never mind.  

I was sailing right along on the early tx leg too, then this AM I woke up feeling like I was wearing a lead-lined suit, followed by the news of the Neupogen this afternoon. Ah well, I sense improved winds from the west in the air.

I think this particular doc's area of research/interest is portal hypertension, so I guess that's fortunate for me.

Goofy <== A couple hairs short of a full coat just now

[FlGuy]

For my schedule do the peg Friday evening, CBC Monday AM.  riba has a half life of 44 hrs but with daily AM+PM dropping it's at a constant level.  Peg has a half life of 27 hrs. So, i figure that by Monday am (60 hours) the peg has had it's max effects to the CBC. But with work and kids have to stick the the schedule I have.  Would prefer the CBC later than Monday but gotta do what you can.  Looking forward to not having track marks - again.  With the peg, insulin, glucose reading, neupogen I make 16 holes a week.  Thank goodness platelets are not too low, I'd be leaking like a sieve.

[jmjm530]

The number to be concerned about is ANC (absolute neutrophils) not WBC.

If your ANC is above 500 you don't need Neupogen yet. I believe H. Hoofnagle and maybe others did a study that showed no increase in bacterial infections on HCV treatment with ANC above 500.

In my case, my ANC was in the 1300-1500 range for most of treatment. About six weeks ago it dropped to 800 then the next week back up to 1100. Then two weeks ago it dropped to 600. Then last week up to 900. In other words, unlike with hemoglobin, a decline in ANC is not always linear. My WBC has been as low as 1.4 and my doctors weren't concerned.

-- Jim

[FlGuy]

Both neupogen and neulasta (pegylated version of neupogen) work fast, unlike procrit (EPO) which is more gradual effect for the reds. Didn't notice any sides with neupogen but neulasta gave bone pain (back and legs) for a couple of days.  ANCs decrease fast too.  I get 'pogen or 'lasta every 3 weeks or so now.  Lot of stuff works on your mind, but I think the 'dragged' out feeling is helped by the neu's.  But, then again, I'm in a fog anyway.

[cougareyes]

You may also consider when you draw your blood in relationship to shot nite. They say the interferon may effect(lower) your ANC and WBC up to 72 hours after your shot.   Peace

[jmjm530]

I wonder then what night in the cycle the studies use? I always try and draw blood on day "6" -- the day before my shot night. That gives me a conservative "trough" value at least for my PCR.

-- Jim

[GoofyDad]

Thanks guys. I'm drawing labs on day 5, since that's a Thursday & it gives me a day of wiggle incase I forget or the surf's up on Thurday leaving me with Friday open (yeah, right). Yesterday the fellow at the lab took like 9 vials, when I said that seems like a lot. Oooops, wrong draw sheet. "Well shove 'em back in dude, I'm low enough already", LOL!

I was dragging butt yesterday, though still able to get to work to sit on my FA there instead of home. I seem to be doing better today. Nurse's first email yesterday said she thought they'd be looking at doing something for the RBC's, then Dr checked in and said he was going after the WBCs/ANC. Hopefully this is just that 2 week dip, and my counts will start improving, toot suite (like that veggie?).

I still don't have the recent labs, but using baseline as an example, do I have my calc correct?

3.7 (WBC) x 36 (Neutro %) =  1,332 ANC

Thanks again friends. You're a huge help.

[GoofyDad]

Well I found fiole's thread from a month or so ago, which put forth the usual well reasoned opinons & debate. I should have looked first. Now, I just need to get my ANC #s tomorrow & I'll better understand where I stand. Given my baseline, it doesn't seem this should come as a huge surprise.  

Kathy (friole), you made a point of going back and adding a follow-up on your progress to the old thread for archival and I want to thank you. Very considerate and helpful.

Now, back to your regularly scheduled thread-jacking.

[FlGuy]

Your calc for ANC looks right.  BTW, Neulasta effects on ANC. ANC's were 653, got Neulasta, following Monday ANC=9428, following Monday ANC=2916, following Monday ANC = 2176.  See what happens this Monday.  It's an elevator ride.

[GoofyDad]

Got my CBC from yesterday. WBC 1.9, Neutros 25, Platelete 81, and hemo is 13 from a baseline of 15.5 two weeks ago. By my calc ANC is a whopping 475. It's confirmed, not only do I look crappy in real life, now I look crappy on paper too!

[FlGuy]

Time for neupogen/neulasta.  I find that the swings in WBC/ANC lot more volitile than hgb and plats.

[GoofyDad]

Thanks Cougar. The Neupogen is on its way. Sorry for confusion on riba reduction. Based on weight, I'm actually overloading right now, and they want to run with that for a while. They expect to reduce at some point, but by then I should be well  inside the guidelines.

[cuteus]

what an odd thing this tx is! ANC so low in only two wks! WOW!
mine held above 1000, for most of the tx, until wk 65, then it dropped to 850, but went back up on its own. What individuality can do for numbers! The hgb did suffer through out, but normalized 3 mo post tx.
Hope all of your bone marrows hold on, for those of you treating.
Scott had some trick about taking the Neupogen at a time when the bloodword would show a good response, but I can't remember if it was the day before bloodwork or what.

[jmjm530]

How are you calculating ANC? I'd double-check the calculations wth your doctor or lab to make sure. My most recent ANC is 975 and my WBC is lower than yours at 1.5. My understanding is that a WBC of about 1.2 or 1.3 would correlate with an ANC of 500 and your WBC is 1.9. The rest of your numbers look OK.

-- Jim

[painintheside]

Hello,
I seen the other posts about your stage. I am a stage 4 and they haven't even considered putting me on a transplant list. I go up to the Cleveland Clinic so I feel assured they are correct. And stage 1 or 2 aren't even considered cirrhosis...not until stage 4.

Go see a different doc! Sounds strange to me. I hope you do well with tx though. I just started tx (had 2 shots so far).

Sincerely,
Dana

[cougareyes]

I believe they used a calculator because their neutrophils were listed out as a percentage instead as absolute. On the janis website there is an expample. wbc x neutrophils % = anc
That is how mine are listed also.   Peace

[jmjm530]

The formula I found appears to be a little different. It is possible that Goofy may need additional bloodwork to calculate his ANC. With Quest's CBC w/diffentials, for example, it's already calculated for you. I just want to make sure he's reacting to the correct numbers as his WBC doesn't look all that bad.

(Neut + Bands) (WBC x 101) = ANC

Complete article for calculation with examples:
http://www.curehodgkins.com/hodgkins_resources/determineANC.html

[GoofyDad]

The lab is just showing Neutrophils and WBC. A few posts up in this thread I asked for guidance on the calc. Hopefully I'm doing it wrong. That would be good news. Neupogen won't arive until next week sometime.

I spoke with the nurse and she has sold me on nausea being triggered by riba pills. They're presribing a 'PPI' (like the little purple pill she says) to help with nausea and as a prophy for other stomach ills stemming from,low plateletes. I thought nausea was from food, but it's true, I eat, then I take riba.

She said they'll prolly reduce my riba at some point (remember me on the scale, Jim??...sorry hope you're not eating) but want to keep me at max for as long as they can. Sounds like they're right on the same page with me.

Just saw your new post Jim, I'll have a look at the calc. My old lab used to show absolutes, now I go to the hospital just cause it's convenient (believe it or not).

[jmjm530]

Just don't take the Neupogen until you know your ANC. If your lab is only showing neutrophils and WBC it's possible you need another test for ANC. Don't really know. I'm also taking the purple pill -- two a day -- for GERD. The nausea you speak of us very common in the beginning of tx and usually gets better.  

I'm a little confused why they're talking about eventually reducing your riba as your Hemoglobin is 13. The only reason you should consider reducing Hgb is if you're anemic and Procrit intervention doesn't work. They're a number of drugs that can treat riba-induced nausea which like I said usually goes away eventually. Reducing riba, especially early in tx, reduces your chance of SVR.



-- Jim

[GoofyDad]

I treat at CPMC. I just stumbled accross this, which shows me as a Neupogen candidate based on pure WBC decline from baseline (3.7 to 1.9).

http://www.cpmc.org/advanced/liver/physicians/hepc-protocol-santacruz.pdf

Not quite a 50% drop for me, but given that it's so close so quick, I'm comfortable with a little early intervention.

I would like to get a handle on the ANC though. I'll persue that.

Goofy

[GoofyDad]

Spoke to the lab receptionist. She thinks bands (and segs too) are soemthing they only see for manual diff (hand done with slide) vs. auto diff (el machino). So lets at least assume I have bands > 0. That alone is an improvement. I'll try to learn more about deriving ANC from nurse and let you know what I learn.

[cougareyes]

Regardless of how you calculate it with your neutrophil % at 25 it is low. When my wbc was at 3 and my neutrophil % at 35 my doc said don't worry my anc was at about a 1000. Im not sure if they do a seperate blood test to get the anc(when listed seperately on the cbc), and some docs just use this as a guessimate.
Jim's right there is nothing in your bloodwork that warrents riba reduction, unless there are other factors that your doc is looking at. Especially this early in the game you don't want dose reduction.

[GoofyDad]

Any hope for the Neupogen to help with not feeling so great? Fatigued, bit light headed, and a touch of nausea... that's the one that get's me.

[jmjm530]

I just looked at my labs again and realized besides calculating the ANC, they also give total Neutrohils%. Your ANC calculation appears to be correct then. What threw me off was the fact that your WBC was higher than mine but your ANC was lower. That's probably why a number of docs, including mine, are mostly concerned with ANC and not WBC.

But with the blood roller-coaster you've been riding, you still might want to do a blood draw a few days before the Neupogen arrives. Both times my ANC approached 500, it jumped over 400 points the next week.

Concur with Cougar about the riba. Try and hold onto the higher dose as long as you can. Use Procrit if necessary. Higher riba levels are associated with higher SVR rates.

-- Jim

[GoofyDad]

Thanks Jim. My nurse emailed that they use the simple calc too. Their guidelines say Neupogen at 500-750 for stage 4; otherwise they'll go down to 250-300. I didn't bother to ask why stage 4 requires earlier intervention; there are certain things I probably don't want to know.

They'll test me for b12 and iron stores next week. I'm really happy with these folks. I'm soooo glad I waited & got into them before starting tx, even if they did sentence me to 48wks instead of 28. No way I would have this access & this care level with the former GI.

Oh, any tips on the nausea from my morning riba? I was eating a cup of good yogurt each morning, but I need to get more. I just started on daily Aciphex, hopefully that will help. I don't know what I'll do if the riba doesn't stay down one time? I don't want to miss a dose of this lovely stuff!

[cougareyes]

Yogurt, fruit, and maybe an english muffin is all I can down in the morning. My appetite seems to get better as the day goes on.
Good Luck

[jmjm530]

Try to take the riba with at least a moderate amount of fat if you can tolerate. It should help with the nausea and will also facilitate riba absorption. Forgot what week you're in but riba associated nausea usually disappears later in treatment. Meanwhile, if it gets really bad there are drugs like Zofran which can help.

-- JIm

[jmjm530]

Re the Aciphex. It needs some protein to activate so take that into consideration when you eat your meal after.

[darcar]

hi all..
question about hepatic panel profile blood tests.
total protein is 8.2 ..normal is 6.0 - 8.3  so this is borderline.
albumin is 4.3..normal is 3.5-4.9 within normal limit range.
globulin is 3.9..normal is 2.2-4.2 ..within normal range
bilirubin total is .53 birn us .2-1.5
bilirubin direct is .11...norm is .00-.30
alk phosp. is 85..norm is 20-125
ast is 85 ....norm is 20-125
alt is 34..norm is 2-60
platelets are 167..norm is 140-400
===============================================================
im concerned about the protein, albumin, and globulin levels..because they seem very close to the upper range normal limit.
the pcr is 403 with peg / riba treatment.
any feedback ..appreciated and thanks.
DarCar

[friole]

I sort of missed this thread until now.  I am actually amazed at how low your ANC got on that second CBC and I think it is good you are getting on the Neupogen.  I do think your calculations of ANC are correct.

I think we almost have to rely upon the doctor's advice for the WBC drops. (I say that even tho I disputed my doc and did not take it when she wanted me to) With the hemoglobin drops it is so obvious to us because the anemia generates such visable side effects.  However, we don't really feel the drop in ANC -- but with that drop our bodies can be much more prone to infection. With winter coming on it certainly can't hurt to try to build the system's defenses.  There is an increased risk of infection in cirrhotic patients as the neutrophil counts drop (according to an article by Clinical Care Options, LLC) thus your doc is right on target by starting Neupogen sooner in those cases.

Personally, my ANC seems to be stabilized at about 1000 - 1100 (at week 12).  I never picked up the Neupogen at the pharmacy although I considered it, just to have it on hand in case. I will get another test this week and see how it is.
Kathy

[GoofyDad]

Well I did start out a few cards short of a full deck, few bricks shy of a full hod, whatever.

In any case, I have the Neupogen & I'll start tonight. We were going to wait for another CBC on Thurs, when I mentioned my concern to the nurse about having a hip replacement in my twenties. The nurse called right back, Uhh the doc say start right away..... let's not wait for the CBC...