Low WBC, RBC & Platelet, should I continue treatment?

[kally291]

I was detected hep C last summer, seems I was infected by blood transmission when I was 3. I'm 23 and started my triple therapy Mar 29. So today is the first day of my 4th week treatment. Feel good during the treatment, less side effect. Only feel losing appetite and hard to finish 20g fat. I took my lab test this Wednesday.
I got the result today, it shows
HCV RNA, PCR Quant    not detec,
HCV Viral LOG               not detec.

But the WBC, RBC and platelet are abnormal, especially for my WBC.
WBC 2.1L    4.0-11.0K/UL
RBC  3.67L  3.80-5.10 M/UL
HEMOGLOBIN  10.8L   11.5-15.5 G/DL
HEMATOCRIT    33.4L  34.0~45.0%
PLATELET COUNT 99L   130-400 K/UL

Should I continue the pegasys injection tonight? I already contacted my nurse, but the phone call turned to voice mail. I read some articles, seems when having a low WBC you need stop the treatment. I'm just shock when I seen this, because I feel everything go through better than I thought before I start my treatment.

Sorry for my poor English, I hope I express everything clearly and offer enough information.

Really appreciate your reply.

[pooh55811]

Several people on the forum have taken Neupogen and several have taken Procrit so they would know the side effects. Those helper drugs have helped many get through treatment and attain SVR. Hopefully you will also get through treatment and attain SVR. Keep us posted.

If you were UND at week 3 and do not have cirrhosis or were not a null or partial responder in the past, then you will probably do 24 weeks.

[kally291]

Hello everyone,

I just get my new CBC lab results
it shows:
WBC  1.5
RBC   3.02
Hemo 9.1
Hema 28.0
Neutorphils 54%
Monocytes 3
Platelet      83

This lab is taken by the end of week 6. I'm just feel afraid that I need to take Neupogen later some time. I heard it has side effect as well and need lab test weekly. Have an appointment with my dc this Wednesday, he has no suggestion about my treatment plan last meeting, but I think I can take only 24 weeks bc I was UND at week 3.

[ceanothus]

This last post "The internet is also full of information that can scare the daylights out of anyone...." Is very true. You really need to filter your information. This forum is one if the best places to get info because it is very self-correcting. When someone posts incorrect info, whether from brainfog, typos, or old-fashioned ignorance, it is always corrected by another member within a day or less. After a pretty short time you will learn which posters are always reliable (or which ones think more like you do and thus make the most sensible explanations for you).

[HepperGirl]

Your insurance company will always tell you to stop treatment and or go to the hospital for every little thing. I have 1.6 WBC as of 5/10/13 and my doctor told me to hang in there so I am. I can only trust my doctor's advice. The internet is also full of information that can scare the daylights out of anyone on this treatment if you let it. I'm on my 24th week but I need to go 48. Keep the faith.

[jules2551]

Thanks pooh! You are correct. Brain fog ughhh

[pooh55811]

Just want to correct something that got posted (due to treatment induced brain fog, I am sure). Neutrophils have nothing to do with bleeding. I am sure Jules meant to say platelets when she was referring to the bleeding and infection when she was referring to absolute neutrophils.

When the Absolute Neutrophil Count gets low, there is a possibility of increased risk of infection. That is why the docs keep an eye on the absolute neutrophil count. If your count does get too low, your doctor can order Neupogen.



  

[kally291]

Yes! No confusion. Soooooooooo happy that I'm UND now! I would have a more positive attitude to fight the 20g fat! Thank you so much! Without you I think I will have depression for the 4th week. :)

[ppmguy]

         so that there is no confusion kally, your stable.  do your shot

[kally291]

Thank you!  I have learned a lot today. You guys are better doctor assistants!!

[jules2551]

OK ok much better.  Your ANC level is 119.  Your in good shape!  It's low but they probably won't bring it up until <50 if not lower.  Enjoy your shot and take it easy over the weekend.  You will be fine

[kally291]

Sorry, the Neutrophils should be 57 40-74%

[jules2551]

If it were me...... I would take the shot.  I never reduced when my Dr's told me to but that is ME!  This is your decision...not mine.  If you do take it just take it easy and don't start up the chainsaw or anything like that :)

[kally291]

Jules,

I'm soooooo sorry. I copied the wrong line. The Neutrophils should be 57 40-74%

[kally291]

Hey Jules,

Sometimes I have gums bleed, but it act the same as I'm not on treatment, so I don't take it into consideration. I will talk to my dr ASAP. So should I do the shot tonight?

[jules2551]

WBC 2.1 Neu % = 12.5% Then your ANC would be .26.  I am surprised your Dr has not suggested Neupogen just to get all of those levels up.  I think I have seen some with that low of range.  It doesn't make you feel bad but can be dangerous if you were in a car accident or something major due to internal bleeding.  You should talk to him about this.  Do your gums bleed or is your urine red?

[kally291]

hey Juiles,

you mean  Neutrophils 12.5 11.0-15.0%, this one?

[jules2551]

I think there are other factors involved before dose reduction is considered.  Congrats on your post UND!

Kally...do you have a Neu # on your lab report?  The range should be around 2.0 - 7.0.  This will be your ANC # and that would determine if you need Neupogen or not.

[kally291]

I find Neutrophils on my lab, it shows 12.5 11.0-15.0%. This one is normal, I only copied the abnormal date. So from this one it looks good right?

[kally291]

hahaaa~ No problem. Feel happy to share with you.

I think my health is in good condition. No smoking, drink little before detect hep C, since July 2012, I quit drinking. When I start the treatment feel less side effects. I think sometimes I feel hard to have 20g fat, bc I don't eat that much before I have the treatment. And I don't choose the right fat source. I feel I don't like peanut butter. Right now I'm having soup with 1 and a half tbs olive oil. Olive oil seems good for our health, :) and it can help lose weight. That's my motivation right now. My suggestion is start 20g fat food a little bit earlier than the treatment. Let our stomach have more time to adjust to new food diet. And choose the right fat source.  

But when I get my base lab test, the WBC and RBC shows close to the bottom line of the range. So that's why I'm very worried about the WBC.

About my does. I have peg 180mg, Riv 1000mg (600mg am,400mg pm), Incivek 2pills per time, 3 times per day( I believe it's 375,but I'm not sure, I will check after I'm back home)

I guess I'm UND so quick bc my viral loading is low. Bc my dr said my viral loading is low when last time I meet with him. If you are interesting I can share with you late after I'm back home.

[Idyllic]

Yes this disease can be very time consuming with the lab visits and doctor appointments and the three times a day you take the Incivek (as well as the doses of Riba). It helps to be organized.

It is a good idea to ask the doctor how low certain values on your CBC can drop and what will he do when they do.


For your WBC the value that it helps to know is the one called Absolute Neutrophils. It might say Neutrophils (Absolute) abbreviated as ANC. That number is used as a gauge rather than the WBC.

So (basically) your Hgb, ANC and platelets are the values to keep an eye on.

[ppmguy]

              i dont recomend dose reduction at 1.6. when i reached that threshold, i was told by tx dr that protocol is dose reduction to 135 and to do cbcs weekly until cbc is stable.  i had 2 dose reductions to 135mcg of peg and i am und for 14 weeks post tx.  so   protocal

                                   barry

[kally291]

Thank you for your numbers. These gives more conception about how low I can go. I think I have waste most of my time with my dr. Next time I should ask him how low he think I can go. :) Anyway, I feel good I'm UND and not very severe side effect. The only thing right now is finish the rest 8 weeks quickly and get rid of Incivek. The 20g fat make my stomach feels bad.

[Idyllic]

I agree with all that has been said. I would just keep having the lab tests when you are scheduled and be sure your viral load draws are scheduled on the right dates.

I am glad you are feeling well.

[Idyllic]

You are in week four and you are UND that is fantastic news :)
On the other hand

Errr...wait a minute just to be clear you started treatment 29 March and you say "I took my lab test this Wednesday."
That means
Friday, March 29, 2013
To and including: Wednesday, April 17, 2013

is 20 days.

3/29 week - 4/5   week 1
4/12 week 2
4/19 week 3
4/26 week 4
___________________________

This is interesting because you are young and presumably in good health (??) and while I would take my shot of Peg I have to say to me at this stage if your dates are accurate these meds are really kicking in.

Can you tell us more about your health and whatever else might matter? I would do my shot as well but I am wondering about your Peg dose and how you are feeling. The reason I ask is because over the next few weeks your values may stablise, gradually drop or plummet.

When I was on Incivek one minute my Hgb was 10.1 and I felt fine and the week after the my Hgb was 8.1.