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Avatar universal

Neupogen?

I was treated 6 years ago for Hep C , genotype 1, as was my husband.  I responded well to the Peg. and interferon and have been undetectable ever since, my husband was a non responder.  He hasrecently started the TX again adding the incivek to the already horrible cocktail of meds.  He is at week 7 and his viral load is undectable which means the insurace company will aprove the rest ot the incivek doses.  However, he basically has no red blood cells, he can barely go to the bathroom with out huffing and puffing for air.  The rest of his blood work is a mess too. The Hematologist said he was going to start him on Neupogen is anyone else taking this and is it working for them. He also said that he may need a transfusion , which is freaking my husband out because that is how we suspect he contracted the Hep c orignally (back in the 80s).  I told him that they screen the blood much differently now then they did back then , but he is still freaking out.  Anyone who is taling Neupogen please let me know if it is helping.
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Avatar universal
Unless I'm misunderstanding something, Neupogen is not the right medication for your husband.  Neupogen is used to increase white blood cells.  You said your husband's red blood cells are down, which means that he is anemic, and the correct management of anemia for someone on triple tx with Incivek should be 1) reduce the ribavirin dosage in 200 increments, 2) transfusion, and 3) Procrit, which is a medication that helps the body increase red blood cells.  
Advocate1955
Helpful - 0
223152 tn?1346978371
I think you need to get a copy of your husbands last bloodwork and post it for us.  A hemotologist should be on top of this so if she suggested  Neupogen that would mean his white blood count is low -- most specifically the absolute neutrophils.

However, it does sound like he has a red blood cell problem and that his hemoglobin is low.  The solution for that is epogen or procrit which helps build red blood cells.

Now he may need both.  I have prescriptions for both but have not needed the neupogen but one time.  The procrit for low hemoglobin I am taking every 5 days and I think it is finally helping (I am on week 27).


Do ask for your copies of your labs. And congrats to your hubby on the UND

frijole
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Avatar universal
I wonder if the doctor said "Epogen" and it turned into "Neupogen".

Mike
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Avatar universal
Oh, that could be true.  Epogen is Procrit.
Advocate1955
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Avatar universal
    Maybe it was Epoetin~ Procrit..... like mikemom said I just started this. lots of people here have taken this for low Hbg. What were he last lab results?
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Avatar universal
maybe that was what he said , but his wbc are very low as well.  His gastro, does not lower ribaviran he will be staying on the same dosage, I think that is something they do when you are in  trial program.  I know it was not Procrit, his hematologist said he does not use that anymore.
Here are his results of yesterdays CBC
WBC 1.6         RBC 2.4
LYM 0.9          HGB 7.3
MID 0.2           HCT23.9
Gran 0.5          PLt 24
Helpful - 0
163305 tn?1333668571
Okay, it would be neupogen for his wbc.
When mine were that low my doc had me take neupogen although he actually looks at anc rather than wbc.
However, despite how low my wbc were, it never made me have shortness of breath.
The ribavarin could be responsible for that.
His rbc are low but nothing to worry about.
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Avatar universal
His HGB is quite low though as well...7.3 soulds like it would hard to deal with.  Ihope the rescue drugs help him to feel better.
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Avatar universal
His Hemoglobin is 7.3 and that's way low!
His HCT is low as well.
I'm not sure about his platelet count but if it's 24,000 that's low too.
His HGB appears to be the most pressing issue.

Mike
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Avatar universal
Sounds like he needs both neuprogen and epogen.   ASAP.   What were the last VL is he UND?.What is the DR rational for not reducing his dose and using procrit... That is  standard care from what I have read.
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163305 tn?1333668571
Oops, sorry I missed that, glad you picked it up, Mike and 1.

Yes, that could explain the exhaustion.
Helpful - 0
1669790 tn?1333662595
The main numbers that I watch are platelets, Hgb and ANC (Gran) /wbc.  They all appear low, but as Mike said, the Hgb (7.5) would cause me the biggest concern since it is Very low.  There are alternatives to procrit, so maybe his office uses something else??  The Gran (ANC) is at the level (0.5) where many GI's/Hepa's will consider neupogen.   Hope you get these under control.
Helpful - 0
223152 tn?1346978371
The "gran" is the absolute neutrophils and they are low - .5 and she probably did suggest Neupogen.  Sounds to me like he needs both and pretty darn quickly.  She seems to be of the opinion that a transfusion will be needed for the low hemoglobin.  At 7.3 he must really be dragging.  Mine has never gotten that low but a lot of folks are experiencing this on the triple.

So how is this going to work out?  You said the GI is not going to reduce ribavirin doseage.  I think the insurance company will get in the middle of this -- they sure did with me.  They would not approve the procrit until I dose-reduced by 200mg on the ribavirin.  I will be really interested to see what your hemotologist can do to overcome this.  However, it could be okay.  When I treated the first time I had a hemotologist monitor my blood and I think she used an oncology code rather than a hep C code , and I never had a problem getting the procrit.  

Your hubby's HGB is probably not going to go up while he is on the Incevik.  At least it is doubtful.  I would hope he gets that transfusion and an rx for procrit.  Do you remember if he got anemia last time?  Even when the Incevik is over, the ribavirn is still a big factor in anemia.  I guess he has to treat for 48 weeks because he is a nonresponder and has cirrhosis.
THe fact that he was UND with triple and a nonresponder last time is incredible.  I certainly hope he can weather this storm and continue.

frijole
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Avatar universal
Congratulations on realizing your SVR and sorry to hear about your husbands prior non -response and complication with this tx...

There are a few things you mention in your post along with the lab values that you included that  seem odd.

" His gastro, does not lower ribavirin he will be staying on the same dosage, I think that is something they do when you are in  trial program."
-------------------------------------------------------

This statement by your doctor along with the fact his HGB. is at a severely anemic level(7.3)  means that  his doctor is not following protocol by not as of yet "reducing Riba by 200 mg increments  "  and /or initiating the rescue drug procrit or one of the other "red cell growth factor" drugs.

Either or both of these strategies should have been done at HGB  <10   to ward off possible need for transfusion.(which should always be a last resort)

Also...his platletts being at 24 is extremely low and could be close to a dangerous level. Has the doctor addressed this and conversed about a  possible reduction of Interferon or even possibly the introduction of the rescue drug " Eltrompobag" to adrress it?? Has he said how low he would allow Plats to go?

Hopfully his doctor is  experinced with treating HCV and if not possibly a referal to a Hepatologist would be a good idea the rest of the way.

Good luck ..
Will
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Avatar universal
Hi thanks for all the input, I really appreciateit.  Let me see if I can address some of the questions.  At week 4 (it is now week 9) he was undetectable. 4 years ago he only took the ribaviron and the Peg.  and he  went out past 50 weeks and he was never untectable, also last time his blood counts were about the same.  The insurance company approves the meds because he was already being treated by the hematologist for thrombocytopenia which is just fancy doctor talk for low platelets, so even before the TX he had low platlets.  He will go on tuesday to the hematalogist for some rescue treatment ( for the life of me I cant remember the name of the two drugs he said he would use, but I know that he does not use Procrit anymore he said there is something new and better he would use .  I just cant remember what its called)   As far as reducing the ribavirin , the insurance company has not asked for any blood work. In fact the Gastro said that they would as at 4 weeks for a viral load and if it was not lower they would not continue the incivik, however they never asked and sent us the whole course of incivek .  I guess it depends on what kind of insurance you have.  His is pretty good the incivik alone is over 16 thousand dollars and we paid a copay of $5.  
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Avatar universal
There's another drug for Anemia called Aranesp, that may be the one being that his HGB is so low. Most people get procit.
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223152 tn?1346978371
Thanks for the answers.  That is remarkable - 50 weeks and never cleared and now UND at week 4.  That is progress.  I do hope one of the rescue drugs is for the anemia.  

frijole
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Avatar universal
There is some confusing i9nformation here. So here is the low down....

Procrit (or Aranesp, which is long acting Procrit) is for the hemoglobin. That is what your hubby needs as his hemoglobin is very very low and it will cause severe breathing problems at that level.

Neupogen is for the white count. His complete white count itself is not considered that low. Much more important is the part of the white count called nuetrophils (or grans). When they fall below 500 is when the need for neupogen becomes important. From wht you've told us, we can't know what his neutrophil count is. You need to find that out.

I wish him good luck.
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163305 tn?1333668571
I thought the anc was missing too.
flcyclist cleared that up in his post.

"The Gran (ANC) is at the level (0.5) where many GI's/Hepa's will consider neupogen. "

BTW: I don't entirely understand but my nurse told me ANC is determined by the WBC.
When my wbc were 1.6, my anc was .5

Sounds like the guy needs neupogen or a reduction in dosage.
Helpful - 0
1669790 tn?1333662595
"BTW: I don't entirely understand but my nurse told me ANC is determined by the WBC"

Although there's a direct relationship between WBC and ANC, the calculation is a bit more tricky than I'd ever want to get into.  Fortunately it is provided on most cbc tests, but sometimes listed as Absolute Neutrophil Count, ANC, Gran, GR#, etc.

If you're really interested to see where the ANC number comes from, see the following:
"To calculate the ANC, the number of white blood cells (WBC) and the percentage of polys and bands must be known.  Then, the number of white blood cells is multiplied by the percentage of polys and bands.

http://www.cc.nih.gov/ccc/patient_education/pepubs/cbc97.pdf
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Avatar universal
There are 5 types of white blood cells.

They are:

basophils
eosinophils
lymphocytes
monocytes  
neutrophils

Mike

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223152 tn?1346978371
Mike has laid out the kinds of white cells very well.  I think the Eos and Basos are baby neutrophils.

The WBC is listed two ways on your CBC.  The absolute counts are are actual number of counted  cells.  If you add up the numbers given for each type of white blood cell, they will equal the total white blood count.
For example, on my CBC from yesterday:
    WBC           1.4
   Neutrophils Absolute)           .9
    Lymphs (absolute)              .4
   Monocytes (absolute)           .1
   All of these equal the 1.4

The other way those same items are given is in percentage of the total white blood count.  Again on my CBC
   Neutrophils           65
   Lymphs                25
   Monocytes           10
THese all add up to 100   (percent)

Interestingly, I read somewhere recently that neutrophils are the only white blood cells manufactured in the bone marrow.

THe only time I have had CBCs with "gran" was when they were run in my internist's office, and I don't think the machinery is as sophisticated as at the labs.  I didn't know until he told me that grans were neutrophils.
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Avatar universal
This is inetersting, thanks for the details...
Helpful - 0
163305 tn?1333668571
mike, flcy and bean:
I'm touched that you guys think I can understand these things.

Actually I did learn something and I appreciate the time taken.

Baby neutrophils sprouting out of my bone marrow?
Now that I can get a grasp of.
Maybe I should start a portrait:
             Mama Neutro and her babies Eos and Basos

Thanks~
OH
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