WBC Count Low; Told To Skip 2 Interferon Shots.

[Carlhcv]

I don't have the numbers but the Doc's office help called me the morning after my latest CBC and I was told to skip 2 shots. She said the number had to have been below 2. I don't have insurance and can't afford special drugs or blood transfusions. Any opinions on this? How will this compromise my tx? I'm on week 18 of Peginterferon, Ribaviron & Victrelis. I thought I was doing pretty well, just mainly short of breath.

[medic54]

flcyclist makes a good point. This decision is certainly base on your Absolute Neutrophil Count and if the 'office girl' can't find it...something is really wrong. The Pegasys disclaimers above must be taken in their whole context though IE-liability avoidance. Almost every study I've read never alter the dosage at all above 500...and I've read a few times that HCV treatment patients shouldn't get into trouble until it gets below 100. But since she couldn't find it ??? and who knows, you could be at ?? And if your doc doesn't call you well I guess you have no choice but to reduce. But you know, if you walk in there they have to let you see your labs. I understand your doc seems like a very honorable person treating you for free (as my grandfather did but those docs are rare today) but you have to be your own advocate because if he/she are wrong...they just move on but you loose. In my line of work, I unfortunately have to step in and become a patient advocate a least once every couple of weeks.

[jules2551]

Go to www.neupogen.com and click on AmgenAssist and answer the questions.  This should get you assistance if not free neupogen

[flcyclist]

Since dose reductions are based on the neutrophil count (ANC), then your doctor must know this number in order to make this decision.  It sounds like his office staff doesn't know how to read the lab report, which doesn't surprise me.  

The following is from the Pegasys package insert: "Dose reduction to 135 µg PEGASYS is recommended if the neutrophil count is less than 750 cells/mm3. For patients with ANC values below 500 cells/mm3, treatment should be suspended until ANC values return to more than 1000 cells/mm3. Therapy should initially be reinstituted at 90 µg PEGASYS, and the neutrophil count monitored."

[Carlhcv]

"You guys are not doctors and cannot advise me to go against his orders"

That didn't come out right! I meant that I wasn't going to ask if that would be OK because the folks here are not doctors, even though many seem to know more. My Dr. is a Gastroenterologist. I don't want to say more because he might see this. I cannot change Drs. because he is treating me for free. That means that I have to be informed and help with my own tx decisions. Thank you all for very knowledgeable and helpful input. My next appt. is June 21. I think that I will take the reduced shot and not skip 2 shots. Apparently he is more comfortable seeing wbc count over 2. Now I need to figure out how to tell him that under 2 is OK and I can get Neup shots for free if needed. With luck wbc count will go up.

[jules2551]

Call back the "office girl" and ask her what your Neutrophil # or % is.  You can calculate your ANC level with knowing your WBC is 1.65.

My WBC was normally under 2 and ANC as low as .31.  I was giving Neup shots for about 1/2 of tx.  Like Cando said you can get it free and she should know how to calculate your ANC levels.

You are going to have to be your own advocate here.  Get all your lab results and make any appt with your Dr quickly

[ActingBrandNew]

"You guys are not doctors and cannot advise me to go against his orders"

Not sure anyone here claimed to be a doctor nor suggested you go against your doctors orders but merely offered suggestions based on life experience. Regardless if you are treating for free, you still have the right to actively participate in your treatment by educating yourself and making informed suggestions. Hope you figure it out.