Aa
ANC Low
I'm on week 17. My week 12 PCR came back DET, not quantifiable. Doc said push on for the year. ANC came back today at .9 and they reduced RIBA to 400 twice a day. I asked about Neupogen and was told to do the reduced dose and then another CBC on Monday. What do you guys think?
My team specifically had me doing CBCs a day or two before shot day.
I could do it on shot day but that makes it a bit harried for the nurses.
The idea is to do your lab as far away from your last shot as possible but before the next one.
If you can do it on Friday and get the results by Monday, I'd do that. Otherwise stick to your plan.
And you have indeed asked the nurse to address the right issues with your doctor.
Good luck.
I could do it on shot day but that makes it a bit harried for the nurses.
The idea is to do your lab as far away from your last shot as possible but before the next one.
If you can do it on Friday and get the results by Monday, I'd do that. Otherwise stick to your plan.
And you have indeed asked the nurse to address the right issues with your doctor.
Good luck.
My understanding is >1000 @ week 12 discontinue tx, <1000, continue SOC, retest at week 24 if DET, discontinue tx.
Looks Iike I'm not getting great advice from the folks I'm seeing. I'm not sure if the NP made a mistake.
I followed up this AM, but have not heard back. I asked nurse to address the following with my doctor:
1) Reducing riba is not the protocol for dealing with low ANC
2) Waiting until .4 or .5 and then neupogen in lieu of reducing intf.
3) Continue with standard riba dosage.
I took the standard 600mg dose last night and this morning. I was scheduled for another CBC Monday, but will move to tomorrow so I can have results by Monday (my injection day), in case I need to adjust INTF or address neupogen.
Looks Iike I'm not getting great advice from the folks I'm seeing. I'm not sure if the NP made a mistake.
I followed up this AM, but have not heard back. I asked nurse to address the following with my doctor:
1) Reducing riba is not the protocol for dealing with low ANC
2) Waiting until .4 or .5 and then neupogen in lieu of reducing intf.
3) Continue with standard riba dosage.
I took the standard 600mg dose last night and this morning. I was scheduled for another CBC Monday, but will move to tomorrow so I can have results by Monday (my injection day), in case I need to adjust INTF or address neupogen.
I'm confused. You're on triple tx with Incivek right? I thought that one of the stopping rules is at week 12 and that you would have to be UND to continue past week 12.
Advocate1955
Advocate1955
I wasn't able to get neupogen in New Zealand, so if my ANC went lower than .6 my interferon dose would have been lowered. It stayed on .6 without going lower.
I agree ribaviron has nothing to do with ANC and shouldn't be reduced because of an ANC result; your doctor has got it wrong.
Riba is important because it pops the oxygen carrying blood cells which pushes the body to make new ones. The new ones don't harbour the virus because the interferon is doing it's work and the riba gets rid of the old blood cells which have been in the body long enough to get contaminated by the remnants of HVC. The bone marrow has to manufacture blood cells faster because of the riba killing them off (hence the pains in the bones/thighs etc). You need the riba - it's working in combination and if those old blood cells hang around the virus grabs hold again.
I agree ribaviron has nothing to do with ANC and shouldn't be reduced because of an ANC result; your doctor has got it wrong.
Riba is important because it pops the oxygen carrying blood cells which pushes the body to make new ones. The new ones don't harbour the virus because the interferon is doing it's work and the riba gets rid of the old blood cells which have been in the body long enough to get contaminated by the remnants of HVC. The bone marrow has to manufacture blood cells faster because of the riba killing them off (hence the pains in the bones/thighs etc). You need the riba - it's working in combination and if those old blood cells hang around the virus grabs hold again.
Are you seeing a hepatologist?
Mine is top notch, goes to all the conferences, does research and transplants.
I only mention this to impress how knowledgeable he is.
He doesn't have me take neupogen unless my anc goes below .5
At first he had me take it when it went below .75 but that's only because I'm post transplant.
Some docs do have people reduce interferon rather than taking neupogen but having you reduce at .9 seems odd.
Most of us here have docs recommending .5 as the cutoff.
Mine is top notch, goes to all the conferences, does research and transplants.
I only mention this to impress how knowledgeable he is.
He doesn't have me take neupogen unless my anc goes below .5
At first he had me take it when it went below .75 but that's only because I'm post transplant.
Some docs do have people reduce interferon rather than taking neupogen but having you reduce at .9 seems odd.
Most of us here have docs recommending .5 as the cutoff.
I saw your post after I sent mine and I see that your HGB. is only 2 points below normal?? If you are not UND. to reduce riba could have adverse effects to success and unless "anemic is is not protocol anyway??
Best..
Will
Best..
Will
Sorry to hear you were not UND. at week 12 .Make sure your doctor does a VL test at week 24 as this is the cut-off point to be UND.(which hopfuly you will be)
As cyclist mentions ANC of 9 is no problem and no rescue drug would be initiated and reducing Riba is not the protocol for raising ANC.
Unless your HGB . is very low(at least < 10 or even lower) to reduce Riba at this point when not yet UND. would not usually be done.
Good luck..
Will
As cyclist mentions ANC of 9 is no problem and no rescue drug would be initiated and reducing Riba is not the protocol for raising ANC.
Unless your HGB . is very low(at least < 10 or even lower) to reduce Riba at this point when not yet UND. would not usually be done.
Good luck..
Will
RBC is just a couple of ticks off normal Hgb good too. I feel great. Huge energy boost now that the incivik is done. I guess I'll follow up with the Doc tomorrow.
Mine is at .6, my doc said when it gets to .5 we will talk about what we should do, maybe Neuprogen. But i think the Fly guy is right, Rib is reduced when the HGB gets low, the ANC is due to the Interferon. This what my Doc told me and that is what I have seen written here. You may want to double check with your doc on that.
The Ribavirin will affect the Hgb and the Interferon impacts the ANC/wbc. If they are reducing the Riba due to an ANC of 0.9, it doesn't make sense. What is your Hbg level? An ANC of 0.9 isn't low enough to consider neupogen in my opinion, but do keep an eye on it. Of course, this needs to be discussed with your trt doctor.
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