TLC 2.8 for last two weeks

My mother had liver transplant two and half months back here in Delhi, India. Till two weeks back she was on PanGraaf 4mg, Wysolone (steroid) 15mg and CellCept 1000 mg a day. At that time (i.e. two weeks back) her blood result showed that her TLC has slipped to below normal (which is minimum 4) and was showing as 2.8. Her Haemoglobin seems to have settled around 11.2. All other results including Blood, LFT, Creatine etc show normal. Doctor reduced her CellCept to 500 mg (from 1000mg) and increased PanGraaf to 5 mg (from 4mg) and Wysolone (steroid) to 12.5mg (from 15 mg). One week later she had the tests done again. The test result shows that her TLC has not moved an inch and is still at 2.8. My father is like panicked (he has always been a bit nervous personality anyway). The doctor - does he suspect virus infection, I am not sure - prescribed a blood test, result of which comes out after a week or so. Is this situation - TLC at 2.8 for two weeks now despite CellCept being reduced to Nil mg - is so serious a problem as to cause worry? I am not sure how serious is this is - I am not doctor. Please give your comment

[Thomas D Schiano, MD]

some patients metabolize the prograf much more than others, especially after a partial liver transplant. It is still early after the transplant.  as long as the liver tests are OK, he shouldn't worry.  They should slowly push the dose of the prograf up, while he is taking the cellcept.

[rbahuguna]

The doctor says he proposes to take my mother off CellCept altogether at some point in time and only PanGraaf will be needed for the whole life - in the meantime the doctor may prescribe CellCept in on / off basis.

[Thomas D Schiano, MD]

i agree with the plan