Dose Drop!

[pj1881]

I was informed today that my hemoglobin level has dropped to 1.6 with 1.5 being the dosage lowering point.  I am at week 33 of 48 with G1a, UND since week 12, 4log drop at week 3.. How much does a dosage drop effect my outcome at this point?? Is it normal to lower dose around this time.  I definitely have noticed a change in my energy level and how I feel in the morning.

[willbb]

  HI PJ.. The whites being a bit low should have no bearing on the way you feel,is is when they get too low you can be at danger of being unable to fight off infections.

  As Suggested above ,maybe have a chat with you nurse about intervention with the rescue drug neupogen if needed before they would dose reduce.

Good Luck

WILL

[pj1881]

I dont feel bad.. I noticed the past few weeks I havent been waking up as early as I am used to.. If it were up to me I would take my same doseage, but if she asks me to lower the dose and I don't and the numbers continue to drop.... She hasnt lowered me yet, I injected #33 this past Friday, I will get two or three more weeks under my belt before my next bloodwork putting me at about week 36-37.... She didnt tell me how much of a change she had planned, but I am currently at 180ug/ml Peg, 1200 Riba (212lb male 38yo G1a)

[Trish77]

A reference for you

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Adherence_10.pdf

[Trish77]

It's not normal to drop dosage at any particular point.  Rule of thumb is to keep dosages above 80% of the total amount required for 80% of the time, while shooting for 100% of your dosage 100% of the time.  If you don't want a dosage reduction, you can talk to your doctor about neupogen and be ready to put it in place if needed.  I don't know how your insurance works and if it takes time for approval but might be a good time to have a chat with your doc about that and be a little proactive with 15 weeks left in treatment.  Neupogen is pretty fast acting so if everything is ready to go then you're ready to go when necessary.

Good luck with this.

Trish

[Fnzol]

I've been on Neupogen for three months and twice weekly keeps my level at or slightly above yours.  I got down to 350 and my case nurse freaked out and put me on the shots.

You're doing fine with those numbers.  

[willbb]

   Those are all respectable no.   Whites are a little low  ..the AB neutrophil(Anc is the one they will watch) and  Below 500  as FIGUY said could be reason to intervene.

  Good luck...WILL

[Bali05]

It is your ANC (Abs. Neuts) that are low 794.
But not low enough for dose reduction or Neupogen.
My hepa makes 500 the limit for intervention.
I have been at 700-800 several times during the last 46wks
but they always bounced back.

[pj1881]

Heres my results in the "low" range..
WBC 1.6 (3.8-10.8) was 2.5 in January
RBC 3.95
Platelet 131
Ab Neutro 794  
Ab Lympho 446    

[willbb]

  Hey pj...your Hgb. is great  and as Dave said if   it truly was 1.6   the least of your worries would have been a dose reduction.....,still breathing would have been more concerning :)

If that is your ANC #  it is also good

Congrats on the good response  ..hang tough

WILL

[FlGuy]

Your WBC of 1.6 is low but it's not a record.  There are several ingredients of White Blood cells and the more important one is ANC (aka Neutrophils or Absolute Neutrophil Count).  Do you see a separate number for Neuts?  Many docs do not take action until they are about 500.  Even then, the more aware docs will prescribe Neupogen rather than to reduce dose of interferon.  Generally, interferon works on the the White Cells and neutrophils where riba abuses the Red Cells and hemoglobin.

[Mary4now]

Oh your hemoglobin looks good (right?)

[pj1881]

You are right, its my White Blood Cell count. My hemoglobin is at 12.9..

[spectda]

That couldn't be your hgb unless your lab reports it differently then most labs. If that is accurate I have a feeling you are the only person who has ever survived it being that low and you would be in the hospital, off all your drugs, having a transfusion.

Did they lower your ribavirin or your interferon. perhaps that number is your WBCs or your ANC.

- Dave

[Junebug812]

Are you sure those are numbers for hemoglobin? When I dropped to 9.7 from 13.5 in about 5 weeks, I was given Procrit rather than having my dose lowered. Procrit has helped significantly.

Best of luck!