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310500 tn?1227304634

? on CBC/HFP and VL during TX

Good Day all and Happy Friday!

Had 2 shots and 12 days worth of Riba at the time of my first blood work this past Tuesday.   Feeling pretty normal, but blood work came back (doc visit yesterday) with low levels of WBC and Neutrophils.  They were:

WBC 3.1 (4-10.5)
Absolute Neutrophils 1.5 (1.8-7.8)
Everything else normal range.

High end of low but dropped a lot from pre-tx test (WBC 8.5 & Neutros 5.7)

Doc says this is not unusual and will check again in 2 weeks when he does my first viral load during tx.  He also says it may recover, level off and be OK.  

As far as the liver panel goes ALT/AST were normal for the first time since June.  They were 34/31 respectively.  All other items on liver panel normal before and now.    I had a recorded high of 299/127.  2 years ago and always before that I know of I was in the 20's.

My questions are:
1.  What is the drug that you take for the WBC/Neutro situation?  Is there anything I can or need to do to aid in this problem.  How low is too low.  Neither the doc or I want to lower the dosage.  Is it the Interferon or Riba that does this?
2.  Concerning the RNA test.  I have an order for a "Hep C viral RNA/PCR Qualatative.   It is thru LabCorp.  Iam questioning because the test used to dx was the HCV QuantaSure Plus (non-graph) which sounds like Quantity not Quality.  What is the difference and is it the sensitivity?  Is Qualatative better?  Sounds better....My Quantasure read 6,120,000.  Looking for less than 61,200 right?
3.  That test leads to next question.  I understand there is a "better" time to do this 4 wk test.  Shot days are Thursday nights.  I am suppose to go for draw 12/10 which is 4 days after the 4th shot.  Does that sound OK?  Both doc and I are limited on what days we can have our pow wows and this works for both of us.  
4. Lastly.  I am hoping the normal ALT/AST is a good sign.  Any input on this result?   Doc seemed excited!

If you need more info, I have some posted on profile.  Ask though if you need more info.  

Thanks in advance!
28 Responses
223152 tn?1346981971
2.  I think the QuantaSure Plus is sensitive to 10IU/mL.  It is kind of queer because the plain old QuantaSure is sensitive to 2 IU/mL.  My doc ordered that once, and I had to watch after that so that he didn't order it again.  I don't know why they ordered a Qualatative test at week 2.  I would have wanted a quantatative myself.   Qualatative will just give you a yes or no, down to the level of sensitivity of the test.  You might check with your doctor before you have the blood drawn just ot make sure and request a Quant.

1. Your ANC and WBC are good, but they are dropping rapidly from your outstanding pre treatment numbers.  Neupogen is the drug of choice to help manufacture some more white blood cells.  There has been a lot of discussion on this board how low you should/can go before boosting the whites (and congrats to your doctor for not wanting to drop doses).  Many doctors want to start the Neup when the ANC drops below 1000 or 800 (1 or .8).  My doctor insisted (I held off as long as I could) when it dropped to 400 (.4).  

3.  To get the best reading for the particular week, it should be the day before the shot.  Therefore the 4 week draw should be the day before shot 5. In your situation, I would go with the flow.  I don't think it is that big of a deal.

4. ALT/AST looks good but some folks enzymes actually go up and down on tx.  Mine did you higher than my normal which was in the 20s. So, I don't think it is a sign of much.

Overall, your bloodwork looks great.   Wtch the HGB (hemoglobin).  Draws every two weeks is good at first.  I think you are doing great.
frijole
Avatar universal
A qualitative test will not give you a number. So you want a quantitative test at this point, like the LabCorp test you mentioned. Another good quantitative is "Heptimax" by Quest Diagnositics. You want to have the blood drawn for you week 4 viral load test, the day before you fifth injection.

It's nomal that WBC and neutrophils drop on treatment. Yours are still quite high. ANC (absolute Neutrophils) usually aren't a concern unless they drop below 500. Yours are 1500.

You didn't mention hemoglobin (hgb), either pre-treatment or now? Ironically, a good drop in hemoglobin isn't bad, because it may suggest the ribavirin is being absorbed efficiently. What is your genotype and weigh and how much ribavirin did they put you on?

The normalization of liver enzymes is always a good sign, but the bottom line is the viral load test. BTW you don't have to wait until week 4 if your doc will write the rx and the insurance company will pay. I had weekly viral load tests from week 1 until UND at week six.

All the best,

-- Jim
Avatar universal
Just to reinterate, LabCorp's "Hep C viral RNA/PCR Qualatative" is the wrong test for you take as your first viral load test after starting to treat. Reason is because it will not give you a number if the virus is still detectible, and you need a number to quantify your viral drop.

If you go with LabCorp, the test of choice at this point would be their Hepatitis C Virus (HCV), QuantaSure™ Plus, Quantitative, TaqMan™ PCR Number 550027 because it has a dynamic range of 10 IU/ml to 100 million IU/ml.

Their other test, the Hepatitis C Virus (HCV), NGI QuantaSure™, Quantitative, PCR
could be probamatic since it only goes up to 2 million IU/ml and would not as accurately reflect a smaller drop as the first test mentioned. Once you test either below 2 million IU/ml or UND, then you could switch to this test because it has a sensitivity of 2 IU/ml.

Alternatively, you could just test with "Heptimax" by Quest Diagnostics. A lot simpler to order for both doctors and patients. Just have your doc write "Heptimax" on the "rx" along with your diagnosis code. BTW not surprising your doc may confused. Looking a Labcorp's Hepatitis test menu (Quest's as well) is enough to give you a headache.

All the best,

-- Jim
310500 tn?1227304634
Thanks for your answers.  That cleared up pretty much everything, but still need to understand the quant vs qual thing better.  Ae both of you saying the Quantity one is better.  Will they not both show if a have the desired 2 log drop?  Are you saying no numbers at all, only pos or neg on the one he ordered?  Glad I questioned why the PCP ordered the Quanta and the Gastro the qual one.  

I don't want to question him of course but I know the "young girl" in the office jotted it down after it came out of his mouth.  I myself did not hear it right then because I did not yet know there was a difference.  I noticed it when I compared the first VL to this order to see if it told anything.

Jim....funny you metion Quest because during the middle of this h*ll my insurance changed.  I have to use LabCorp if I want insurance to pay.  

Red blood cells.  After reading your post Jim, I pulled those labs out again and they have dropped from the base.  Still in normal range, but lower.  Scary to me because I hate the thought of slowing down.

Current Hemoglobin is 12.8.  Started with 14.2.  

I am about 10 lbs overweight according to the BMI test that we all hate.  I am taking 1000 riba a day (3+2).  I am a lucky geno 2 (lucky?)  24 weeks standard go at it.  No other medical problems at all,  but I understand my viral load (7mil) and age (52) are not exaclty my friends.

Oh....the test dates.  I'm Ok with every 4 weeks and I think that is what he is looking at.  Just want to do the right test.  I am not a fan of the vampires but are you saying whenever he wants to pull blood for the counts, to ask for the viral load to be run to.  What advantage is there in knowing so often versus every 4 weeks?

Thanks to both!

310500 tn?1227304634
Just dawned on me....I saw some recent posts referring to Positive vs negative with no mention of numbers.  Is that what you mean by a qualatative test?  

Assuming my assumption is correct (ugh) and someone gets a "negative".  How sensitive is that?  If it is negative does the number matter?  

Am I getting this at all??????  
Avatar universal
MEDICAL PROFESSIONAL
The test you want at this point in time is the NGI quantasure Labcorp#140639. It will give you quantitative information AND the highest sensitivity that currently exists (2iU). If you are NEG by this test you are as UND as you can possibly get by testing. Other UNDs are not as meaningful , because the sensitivity cutoff is critical. What does UND mean: It means that the test ordered has not found any virus using ITS sensitivity limit. Therefore the most sensitive test is the best.

If you are still  in the positivbe range, you still get a quantitative number with that test , not just the answer "positive", so you know WHERE YOU CURRENTLY STAND with your VL..

The reeason why some docotors/insurances will not order this test is, that it is the best, but also more expensive than other PCR/TMA tests for HCV. The second reason is, that they simply do not know.

And, because of its extreme sensitivity, it has an UPPER limit of 2 million iU. That is its only drawback for patients with a very high VL. Clinically it does not make a big difference .
Avatar universal
The reason I suggested Quantasure Plus, and thereby sacrificing 8 IU/ml,  is because it had a wider dynamic range with a high end of 100 million IU/ml while Quatasure only goes up to 2 million. Since this would be H20's first test, my reasoning is that Quantasure might not be able to quantify his response if his viral load turned out to be over 2 million.

-- Jim
Avatar universal
OK. I re-read your post, and see your reasoning that clinically no different if over 2 million, and probably that's true in the vast majority of cases. Still, Quantasure would make plotting a slow viral decline easier and what if he has some sort of autoimmune reaction and his viral load actually goes up beyond his 6 million pre-tx vira load? Quantasure would not flag that, yet it might warrant pulling someone off treatment.
Avatar universal
Yes, a "Qualitative" basically gives you a "yes" or "no", or as stated on my qualitative -- either "Virus detected" or "Virus not detected". Different qualitatives have different sensitivities but mine went down to 5 IU/ml. This is a very good test to take after you're UND, but its limitation prior to being UND is that you will not get a number. As to test frequency, the advantage to doing weekly viral load tests is that they give the treatment doc more of a heads-up how things are working, allowing him the opportunity to tweak meds, if that is his practice.

-- Jim
Avatar universal
Thinking it over, probably not much significance  between a reading of 2.1 million and and 6 million, given his pre-tx viral load of 6 million -- but I still think a larger dyamic range would have certain "alert" benefits should viral load actually increase with tx, rather than decrease.
Avatar universal
Thinking it over, probably not much significance  between a reading of 2.1 million and and 6 million, given his pre-tx viral load of 6 million -- but I still think a larger dyamic range would have certain "alert" benefits should viral load actually increase with tx, rather than decrease.
Avatar universal
MEDICAL PROFESSIONAL
Since I know the true technology behind both tests, i can tell you that the false positive issue and the true true sensitivity limit are in favor of the Ngi quantasure, which in reality is a double test - it starts with a quant PCR, using 100ul of serum, then, if neg, it continues with a full 1ml of serum, fully worked up to completion to catch every little virion in existence in this ml, often being even more sensitive than the nominal 5copies/ml. Please note :copies, that is individual virions.
The TMA test is a bit more prone to false positives in the lowest numbers because of the contamination issue that exists and other issues.

As I stated before , the whole iu issue is a shameful development, because it uses an absurd unit for something that can be counted. Next time you see 25 people in a room and are asked how many do you see, you would have to answer: "Ten manunits".  Now many forget that their true virus number/mlis actually 2.5 times higher than their "viral load"?  So "my VL is 1million" is understood by most patients and docs to mean that they have 1 million viruses /milliliter of " blood".  Quite misleading. You might note that I painstakinkly attach the iU sign after every mentioning of a number, but I am sure that does not help in many cases.

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