? on CBC/HFP and VL during TX

[H20Lover]

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!

[copyman]

you have every right to request the "best" test for the ever important 4 week draw. this is perhaps the most important bloodtest during tx. i would not say anything to the insurance company, just get the best test done and they most likely will pay for it. once you call them it will be put on record and they will be looking to not pay it.  personally for the 4 week test i would want the best test even if i had to pay for it. best of luck

[jmjm530]

Hgb drop seems about normal. Ideally, you should be on weight-based ribavirin, even though you're a geno 2, but perhaps you already are.

As to the hematologist, yes, many gastro's do not treat anemia in house and refer to hematologists. The problem sometimes comes that the hematologist is not as familiar with SOC induced blood disorders as they should be. Best to monitor blood as frequently as possible and stay on top of things.

Back to the tests, yes, a qualitative just gives you a "yes" or "no" and it's not what you want for your first viral load test. Apparently HR and I disagree on which LabCorp Quantitative to take, for reasons we both have given.

I do know some doctors actually run two tests at times. Depending on your doctor and insurance, this is one possiblity. Using the same blood draw, run the test HR mentions for low end sensitivity and the one I mention for a wider dynamic range.
My concern again -- and statistically the chance is very low -- is that if you run the Quantasure, you won't know if you have an autoimmune reaction to the drugs, i..e. where your viral load actually goes up. Using both tests simultaneously (for the initial test) will cover you both way.

-- Jim

[H20Lover]

Forgot to ask you.....did my small drop in Hemoglobin mean anything?  I suspect I should watch that too?  Was that enough drop to indicate good absorbtion of the riba?  

Also, while we are on the subject.  I asked doc about Procrit and the (nupra something) one for the neutrophils.  He said if I needed those he would probably turn me over to a hematologist.  Is that normal practice for a gastro?  Is this an issue I can push with him to avoid yet another doctor?

Thanks!

[H20Lover]

Good morning!

Thank you both for your responses.  I feel very special that you took your time to help me.   Sorry for just now replying, but I was away from the computer all weekend trying to enjoy life!  But I could not wait to hear your answers.

So....I will call about making a change.  

I understnad HR's reasoning for the "better" test.  I do not know if it is covered by insurance or not at this point.  With it's limit I agree, if I am still over the 2mil IU, then I did not have a 2 log drop and I suppose the exact number is a mute issue.  But could it actually go up????

I will check with UHC and if it is covered I will ask for that one.  If not, I may have to go with the Quantasure Plus because I know that one is covered.  

This discusion though prompted a couple of questions of other questions?  The ceiling seems mute, but can that sensitivity area between 2 IU's and 10 be the diference betwen SVR and relapse?  That concerns me.  Any statistics on that.  Any possibility people were really not undetected because of a high threshold or poor testing methods?

Gentleman, I do have a small issue with "telling the doc what to do".  I can't be sure if it was the nurses mistake or his.  As I said in the original post my first test was the Quantasure plus (10-100 IU/ml) that my PCP ordered.  He had to call the lab though and ask.  He was honest about that and told me he wanted to be sure.  That is the test Lab corp told him to run, but it was for diagnosis not for treatment response.

Either way, I have to call the doc and tell him I am questioning his orders.  But it's my body....right guys?  Nothing personal, I will tell him I questioned it and called LabCorp.  I have already told him about this website and he told me to not believe everything I read.  

By the way Jim, unless your reference to "him" is a clinical reference, I am a womanunit.  


Thanks so much, if there is anything else you can add, feel free!

Have a stellar day!

[Hepatitis Researcher]

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.

[jmjm530]

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.