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Hepatitis C - Low Blood Count
Hi Everyone,
My Fiance' is now on her 12th week of treatment which includes Victrelis / Boceprevir and at this stage her
white blood cells, Red Blood cells along with her platelets have all dropped below normal levels.
She is now due to have one more blood test before her hepatologist makes a decision whether to give her shots reduce strength of medication or not.
Has anyone received these shots and on average how long do they have to be taken?
I have read they can be very painful related to creating the Red Blood cells from the long bones.
My Fiance' is now on her 12th week of treatment which includes Victrelis / Boceprevir and at this stage her
white blood cells, Red Blood cells along with her platelets have all dropped below normal levels.
She is now due to have one more blood test before her hepatologist makes a decision whether to give her shots reduce strength of medication or not.
Has anyone received these shots and on average how long do they have to be taken?
I have read they can be very painful related to creating the Red Blood cells from the long bones.
Her Red blood cells have now dropped to 8.0 and now has chosen procrit in which to increase her Red blood cells as this week she has been very very weak.
If she becomes any weaker she has to admit herself into emergency for a Blood Transfusion.
If she becomes any weaker she has to admit herself into emergency for a Blood Transfusion.
there are dangers to adding additional drugs, so if not necessary they shouldn't be used. Hopefully you have a doctor who understands the appropriate time to use them. Sometimes you can't get through tx without them and personally I am not fond of dose reductions.
I used nuepogen which gave me some pain and discomfort, I wouldn't call it close to extreme though. Epogen/procrit gave me no pain at all. I also took neumega for very low platelets, the neumega was not painful but for me had the most serious side effects.
Good luck,
-Dave
I used nuepogen which gave me some pain and discomfort, I wouldn't call it close to extreme though. Epogen/procrit gave me no pain at all. I also took neumega for very low platelets, the neumega was not painful but for me had the most serious side effects.
Good luck,
-Dave
Many thanks for your reply towards my post!
Apparently my Fiance' Bobbie now being on her 13th shot with Victrelis and just had an addittional blood test where the blood cells have risen slightly. At this present stage she has not been given any Epogen to increase her blood cells.
As explained by some members this is a standard procedure on treatment but once you get results from your local Doctor they do tend to scare you.
Where as your hepatologist is use to handling the low blood count.
AS explained by members along with the link "Willing" supplied
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AntiviralDrugsAdvisoryCommittee/UCM252343.pdf
You will see a chart that Merck "Victrelis" has provided amongst information giving detail of the blood cells dropping from start of treatment until the 12th week and then levels off, once treatment is completed the blood cells will rise back to normal.
Luckily Bobbie has not had to receive the shots as yet as she was not looking forward to them, as many patients suffers severe side affects for approx 2 days and then symptoms of pain eases off and depending how many you have to take a week.
What week of treatment are you in?
We wish you all the best, and hopefully a sucessfull result at the end.
Apparently my Fiance' Bobbie now being on her 13th shot with Victrelis and just had an addittional blood test where the blood cells have risen slightly. At this present stage she has not been given any Epogen to increase her blood cells.
As explained by some members this is a standard procedure on treatment but once you get results from your local Doctor they do tend to scare you.
Where as your hepatologist is use to handling the low blood count.
AS explained by members along with the link "Willing" supplied
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AntiviralDrugsAdvisoryCommittee/UCM252343.pdf
You will see a chart that Merck "Victrelis" has provided amongst information giving detail of the blood cells dropping from start of treatment until the 12th week and then levels off, once treatment is completed the blood cells will rise back to normal.
Luckily Bobbie has not had to receive the shots as yet as she was not looking forward to them, as many patients suffers severe side affects for approx 2 days and then symptoms of pain eases off and depending how many you have to take a week.
What week of treatment are you in?
We wish you all the best, and hopefully a sucessfull result at the end.
yes i have used procrit and i just could not take it. now im on telepravir, riboviran and pegasus. 12 hours in im feeling pretty good.
Many thanks for the information provided also the link to Merck's blood count chart as you stated
after week 12 on treatment everything should stop dropping!
Also glad you mentioned the (ANC) Absolute Neutrophil Count which provides the risk of picking up infections which i was not given last time but will be asking this time.
Two weeks ago Bobbie had caught an Upper respiratory infection and still has it full of congestion.
Thanks Again
Cliff
after week 12 on treatment everything should stop dropping!
Also glad you mentioned the (ANC) Absolute Neutrophil Count which provides the risk of picking up infections which i was not given last time but will be asking this time.
Two weeks ago Bobbie had caught an Upper respiratory infection and still has it full of congestion.
Thanks Again
Cliff
I know the drop relative to normal can seem scary - but there's nothing unusual happening, it's an expected sx of the meds. Overall the current numbers don't seem a cause for concern. The platelets are great, the HgB and HCT have passed the anemic threshold, but not by much, and the WBC is low but has room to drop (you should also be tracking ANC - another key measure of WBC function). There doesn't seem to be any urgency, but it's probably wise to start preparing plans in case WBC and RBCs drop much further.
You can get an idea of the expected RBC decline with VIC from Figure 11, page 77 of
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AntiviralDrugsAdvisoryCommittee/UCM252343.pdf
as you can see by w12 the worst of the damage should be over and things should start to level out.
Whether to add epo at HgB 9.0 is primarily an issue of comfort. If Bobbie has no history of cardiac problems, just pushing on is also an option. As a comparison point, from my last CBC Hgb 9.2, HCT 29.9, WBC 1.3 and Plt 53. Levels have probably dropped a bit more since then, but my Dr has seen no need to intervene yet.
You can get an idea of the expected RBC decline with VIC from Figure 11, page 77 of
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AntiviralDrugsAdvisoryCommittee/UCM252343.pdf
as you can see by w12 the worst of the damage should be over and things should start to level out.
Whether to add epo at HgB 9.0 is primarily an issue of comfort. If Bobbie has no history of cardiac problems, just pushing on is also an option. As a comparison point, from my last CBC Hgb 9.2, HCT 29.9, WBC 1.3 and Plt 53. Levels have probably dropped a bit more since then, but my Dr has seen no need to intervene yet.
It appears to me that Bobbie will settle for the shots in which to increase her blood cells.
last week her blood count was:
NORMAL
WBC 2.1 4 - 11
HGB 9.0 12 - 16
HCT 25.1 37 - 47
PLATELETS 128 150 - 400
Had a new blood test thismorning but will not have the results for another 1-2 days so this being the first lot of results i do not know how rapid the cells are dropping.
last week her blood count was:
NORMAL
WBC 2.1 4 - 11
HGB 9.0 12 - 16
HCT 25.1 37 - 47
PLATELETS 128 150 - 400
Had a new blood test thismorning but will not have the results for another 1-2 days so this being the first lot of results i do not know how rapid the cells are dropping.
Cliff, I wouldn't go for transfusion as a therapy unless it was truly needed. Side effects from epogen/procrit (eprex in Canada, just to make it more interesting!) are very minimal to none for most people, is my experience and my own experience. Neupogen sometimes brings with it some bone pain but is tolerable. I'll let other folks weigh in on that one, since I only got one neupogen shot in me before the whole thing stopped. Transfusion is usually when the hgb drops below 8.0 as a quick way to bring the blood levels back up. I think her doc putting her on epogen at 9.0 is a good move as it takes a few weeks before you start seeing results.
How are her viral load test results coming in? Wish her good luck with this...and you with coping with all this!
Trish
How are her viral load test results coming in? Wish her good luck with this...and you with coping with all this!
Trish
Hi
many thanks for your replies, it is educating to know different names of the same drug along with how different patients coped on the treatment, especially if you have only heard of negative stories all the time.
As i stated in my previous post of the shots named Epogen & Neupogen were recommended to her.
Apparently Procit is the same drug as Epogen there are two Brand names and two generic names to this drug which is a suprise to me, i would expect a brand Name & generic name only!
Link explaining the drugs: http://www.medicinenet.com/epoetin_alfa/article.htm
many thanks for your replies, it is educating to know different names of the same drug along with how different patients coped on the treatment, especially if you have only heard of negative stories all the time.
As i stated in my previous post of the shots named Epogen & Neupogen were recommended to her.
Apparently Procit is the same drug as Epogen there are two Brand names and two generic names to this drug which is a suprise to me, i would expect a brand Name & generic name only!
Link explaining the drugs: http://www.medicinenet.com/epoetin_alfa/article.htm
If your fiance is experiencing a continued drop in red blood cells, a shot known as Procrit or epo will help her hgb level. At 9.0 she may be experiencing some discomfort, but everyone has a different tolerance level. It is not unusual for doctor to prescribe the Procrit shot when hgb gets below 10. My husband used Procrit for a long time during treatment (about 2 years) and did not suffer any pain from it at all.
My husband also had transfusion during treatment, because it took the Procrit a few weeks to work and anemia was significant, but transfusion has its own set of concerns as well -- not so much for hep c, as it is screened for hcv now, but pose other risks different from those of Procrit. I will say, though, my husband much preferred the Procrit shots to transfusion... it became necessary for him as a safety net when time was not a luxury, but transfusion only provides a temporary reprieve, and frequent transfusions is really not a good alternative... most folks tolerate Procrit just fine.
Neupogen is a shot that is used to raise WBC levels -- I don't have much experience with it, I've heard some folks have some difficulty with it, but your girlfriends WBC levels may not make that urgent at the moment. As willing stated, worth discussing 'guidelines' and 'parameters' with the doctor to get a better understanding of what intervention they recommend, when they recommend it, and why those recommendations vs. other options. Best of luck to you and fiance. ~eureka
My husband also had transfusion during treatment, because it took the Procrit a few weeks to work and anemia was significant, but transfusion has its own set of concerns as well -- not so much for hep c, as it is screened for hcv now, but pose other risks different from those of Procrit. I will say, though, my husband much preferred the Procrit shots to transfusion... it became necessary for him as a safety net when time was not a luxury, but transfusion only provides a temporary reprieve, and frequent transfusions is really not a good alternative... most folks tolerate Procrit just fine.
Neupogen is a shot that is used to raise WBC levels -- I don't have much experience with it, I've heard some folks have some difficulty with it, but your girlfriends WBC levels may not make that urgent at the moment. As willing stated, worth discussing 'guidelines' and 'parameters' with the doctor to get a better understanding of what intervention they recommend, when they recommend it, and why those recommendations vs. other options. Best of luck to you and fiance. ~eureka
Before dose reduction ask about procrit and nuepogen it has helped h me in the past and I was on both at the same time. There are a lot of people on this site using rescue drugs now. Good luck. Joe
Hi
Many thanks for your replies,
My fiance' will be due to receive some shots shortly but not long ago her friend passed away with Lung / Brain cancer had to take the shots and did not get on with them at all, i think it was epogen & neupogen she had.
I have a friend who is a nurse and stated to me it may be wise to consider / discuss with Hepatologist a Blood Transfusion where as there will be no pain and your body will improove more quickly as the shots can be painful and take time to work and build up your blood cells.
other than the Blood Transfusion i doubt very much she would like the idea
(Not stating she would turn it down) but it was a Blood transfusion that she caught her Hepatitis in the first place.
her blood count at present is
FIANCE' NORMAL
WBC 2.1 4 - 11
HGB 9.0 12 - 16
HCT 25.1 37 - 47
PLATELETS 128 150 - 400
Many thanks for your replies,
My fiance' will be due to receive some shots shortly but not long ago her friend passed away with Lung / Brain cancer had to take the shots and did not get on with them at all, i think it was epogen & neupogen she had.
I have a friend who is a nurse and stated to me it may be wise to consider / discuss with Hepatologist a Blood Transfusion where as there will be no pain and your body will improove more quickly as the shots can be painful and take time to work and build up your blood cells.
other than the Blood Transfusion i doubt very much she would like the idea
(Not stating she would turn it down) but it was a Blood transfusion that she caught her Hepatitis in the first place.
her blood count at present is
FIANCE' NORMAL
WBC 2.1 4 - 11
HGB 9.0 12 - 16
HCT 25.1 37 - 47
PLATELETS 128 150 - 400
the numbers really matter here - what are current levels and is the drop fast or gradual. Tracking your CBCs is the best way to monitor the situation. For RBCs, an HgB drop down to the 8s doesn't require intervention/reduction unless she has a history of cardiac problems (but life may start to get a bit limited). For platelets, drops to 20s seems OK at which point reduction/transfusion is required. For WBCs my Dr. has no problem with WBC 1.3/ANC 0.5 but as Sandysf mentioned, Neup. and/or dose reduction kicks in at some point.
There seems to be a lot of variability between Drs in when/how to intervene and it's best to be part of that decision. For example, anemia is no fun, but need not involve either epo or dose reduction.
There seems to be a lot of variability between Drs in when/how to intervene and it's best to be part of that decision. For example, anemia is no fun, but need not involve either epo or dose reduction.
Cliff,
I am sure others will chime in, as I am not familiar with procrit, which is the drug to increase RBC count, but I have used neupogen which is the one doctors prescribe for low white blood counts. I have been on weekly neupogen shots for 6-7 weeks now and other than the first shot (where I had some bone pain) I have not had any symptoms at all from the neupogen. It just depends on the individual. What I do know is that using these rescue drugs is preferred over reducing medication. I am also on Victrelis and have just had my first dose reduction this week, they reduced my ribavirin from 1000 mg to 800 and my interferon to 135. I feel okay with this as I am on week 14 of treatment and was UND at week 7 and had a 4 log drop from baseline to week 4. So I think I am in pretty good shape.
I think the length of time the medication has to be taken completely depends on response and the individual.. some are on the rescue drugs the entire treatment time and some people just need them temporarily. Sounds like she has a competent doctor though and that is half the battle!
I am sure others will chime in, as I am not familiar with procrit, which is the drug to increase RBC count, but I have used neupogen which is the one doctors prescribe for low white blood counts. I have been on weekly neupogen shots for 6-7 weeks now and other than the first shot (where I had some bone pain) I have not had any symptoms at all from the neupogen. It just depends on the individual. What I do know is that using these rescue drugs is preferred over reducing medication. I am also on Victrelis and have just had my first dose reduction this week, they reduced my ribavirin from 1000 mg to 800 and my interferon to 135. I feel okay with this as I am on week 14 of treatment and was UND at week 7 and had a 4 log drop from baseline to week 4. So I think I am in pretty good shape.
I think the length of time the medication has to be taken completely depends on response and the individual.. some are on the rescue drugs the entire treatment time and some people just need them temporarily. Sounds like she has a competent doctor though and that is half the battle!
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