BLOOD GUYS/GALS, NEED HELP!

[orleans]

Hey, Back story-Did my CBC 8/22, 2 weeks into treatment. I do these at a great little local hospital and often as not I just wait in the waiting room for my results, takes them about 30 mins. Well I was doing a pcr this time which goes to lab corp so I didn't wait. I was supposed to get them in the mail. It takes 10-12 days for that. I expected my CBC to come earlier but when they didn't I didn't think much of it. Finally, today, I went there to see what was up. The work had just been faxed to my Dr and put in the mail to me. Turns out the delay was that a "path review" was in order. That means the pathologist had to review it. He did that on the 25th and I don't know what or where the report has been the last NINE days!! (I will find out!!) THE NUMBERS

Base line                                        8/22

WBC 3.8 L                                          1.9 L
PLT 151                                            109  L
seg% 50                                            28  L
lmy% 35                                            50 H
neu absolute 1.9 L                                 .5 L
mon absolute.4                                      .3 L
path review   neutropenia and thrombocytopenia
commentsfew large plts noted
I intend to go get a blood draw in the morning as these #s are 2 WEEKS OLD! NO TELLING what they might be now!! I WILL BE FIT TO BE TIED IF THIS SOME HOW THREATENS MY RESPONCE! NEED SOME IMPUT GUYS! jerry

[orleans]

thanks jim

[jmjm530]

FWIW I tested weekly starting at week 1 until I was UND at week 6. After that, the plan was to test viral load monthly, but I probably ended up testing every 2-3 months on average. Again, those tests were too stressful on a monthly basis for me, but that's just me.

[jmjm530]

Peronally, I would test again at week 4 (day before fifth injection), simply because it's a benchmark. Then (assuming UND at week 4)  week 8 (optional) but definitely test at week 12.

Beyond that, my doc tests VL monthly but I found that too stressful. A good compromise might be to test at weeks 18, 24, 36 and EOT, assuming you went 48 weeks. You'd have blood drawn for the EOT test six days after your last Peg injection.

If money becomes a factor, the key test dates IMO are weeks 4, 12, 24,36 and EOT. I suppose one could argue why test at week 4 if you were UND at week 2, but again it is a benchmark point.

[orleans]

So, how many and how often would you do pcrs from this point forward? Keep in mind that I will be paying for them and am not wealthy, I mean I'll do what I need to to keep as much stress down as possible. jerry

[jmjm530]

That test and sensitivity is just fine, Jerry. But, for next time, if you want one that has less irritating wording -- plus it goes down to 5 IU/ml -- try this  test from Quest Diagnostics. It's called "HCV RNA QUALITATIVE TMA" sometimes just written:
"HCV RNA QUAL TMA". The read out either says "virus detected" or in your case it will say "virus not detected".

-- Jim

[orleans]

Been expecting that question from ya-lab corp hcv quantasure plus 10-100,000,000. I know it isn't the very most sensitive but I am pretty happy with it. I LOVE the wording  "Less than 10 IU/mL indicates either complete absence of HCV RNA or in rare cases, low copy number below the detectable limit of the essay." Think I might frame this thing! You think it is worth irritating my good Dr (AGAIN!) by asking (insisting) on the more sensitive test. I had to straighten him out about the extra PCRs, I mean GOOD NITE!, I'm paying for them out of pocket, it seems reasonable that I get whatever I was willing to pay for! He agreed. jerry

[jmjm530]

Well, maybe that's why you havent heard from him. The CBC doesn't concern him, as it wouldn't my big wig doc. So that's great. Hgb looks good. Can I ask how sensitive was the viral load test they used?

[orleans]

hgb is fine 8/8 16.1 8/22 15.9 Dr G. Is a big wig of sorts. Pro. of Med., hepatoligist, text book published teacher at Emory in Atlanta. I totally owe this to the great help I recieved from this forum. How would I have known to dump my under informed GI, or anything else for that matter. jerry

[jmjm530]

Alternatively to lining up another doc -- if your doc is someone you can work with -- then you can start collecting some studies on Neupogen, ANC, etc. FWIW my ANC dropped to .320 and I remained on full-dose Peg without Neupogen. A couple of weeks later my ANC was over 1, all by itself. The reason for the concern re ANC has to do with cancer patient studies that showed higher infection rates with low ANC. Some newer Hep C tx specific work found no correlation between interferon-induced low ANC and higher infection rates on tx -- therefore why some docs like mine rarely dose reduce based on low ANC or rarely use Neupogen.

[jmjm530]

My liver specialist probably would not be concerned but be prepared for some flack on your neut absolute at ".5".

How sophisticated is the doc who is treating you? If real sophisticated, they will let you continue with full meds (Peg) either with or without the helper drug, Neupogen. My doc probably would just let you go as you are, no reduction and no Neupogen. Other hepatologists might start Neupogen. But what you really don't want is a dose reduction so early to compromise that RVR.

SO...if you sense your docs might want to dose reduce, the proactive thing would be to line up another liver specialist (hepatologist) just in case. Also, keep in mind that ANC tends to bounce around a lot. So, the value today might be quite different from when that blood was drawn.

BTW I didn't see your hemoglobin (hgb) numbers. That's an important one.