WBC Count

[sizzy]

I have been off the Pegsys (180 mcg) since 8/10 and the Riba (800 mg daily) sine 8/14. I started the RX after 8 mo of blood tests,biopsy,etc. I started with a low platelet count but had been maintaining at about 78,00 to 80,00 for several months.  Just prior to starting my platelets dropped to 65,00 but my WBC's RB's and Hemoglobin and Hematocrit were holing at good values.
On 8/11 (started Rx on 7/27) my Platelets had dropped to 23,00,my WBC's are at 1.4 my RBC's are dropping from where they were.
1) Since I have pulled from the RX how long does it take to get back to " normal"? I have felt worse now then I did all year and even on the RX other than what you would expect as "normal" for RX
2) I have read that other people continue the RX even when there blood values drop. Fatigue is not a word for how I feel. Pale and out of breath on excertion

[sizzy]

Ex-Nurse and so it makes me more dangerous. Since I have found this site I have found more information than any other hep site I have been to. Of course when I first found out I went through the usual. Acceptance (turned out it was shock)...let's get the cure.....why now.....information junkie to I'm sick of all the info.
I have a good health plan and for the first time in 8 years at my job I have had to use my sick time. I'm on FLMA right now.
I do have a good lab site to go to that has been very helpful and have learned a lot. Sometimes there is more questions than amswers.
Today as I was in the forum I saw that there is something for the cracked lips at the corners and the sores in my mouth and my sore tounge. The doctors have the standard "it's part of the Hep C and or now it is because of the RX" So thanks for ther information and I will stay posted to the site

[Bill1954]

Hi Sizzy;

Our stats sound somewhat similar- GT-1 with grade 3, stage 3/4 fibrosis. Also hepatosplenomegaly per U/S scan.

Remember that there are no docs on board here; only patients with a limited amount of knowledge, and certainly no authority.

As an RN, you’re likely far ahead of the knowledge curve than most of us. From anecdotal reports from patients as well as a little learned info, even aggressive Hematologists begin to intervene with treatment as platelets approach 25 to 30 K. There is a promising new platelet drug in trials right now (Eltrombopag) that might help down the road, but for now, dose reduction might be the best option. I really don’t know the point where bleed-out occurs- it might be as low as 10K, but I wouldn’t want to find out! INR/protime plays into the equation as well.

Regarding WBC’s, most doctors use results from absolute neutrophils generally guide intervention. I believe most doctors try to keep us above 300, but higher for health care workers or anyone else that might be exposed to infectious pathogens. This can be effectively managed with Neupogen, or the pegylated version Neulasta. I’m surprised to hear you haven’t been offered it already- the reason I asked were you live is that some countries (the UK and AUS, for instance) have National Health Care Plans and are sometimes reluctant to pay for these meds- they’re expensive.

For hemolytic anemia, we primarily watch hemoglobin values. If HGB falls below 10.0 (or more than a 3 g/dL drop in several weeks), it’s time to intervene with EPO/Procrit/Epogen/Darbopoetin (sp?). At around 8.5, most doctors will consider transfusion. That should give you a range to consider.

Here are a couple of sites that you might find interesting:

http://janis7hepc.com/
A comprehensive site dedicated to all things HCV. Scroll down and click on an item of interest in the blue box.

http://www.labtestsonline.org/
Provides an overview of labs and values, but not specific to HCV.

Good luck with your treatment, and stay in touch—

Bill

[sizzy]

Thanks,
Live here in AZ. 62 yr old female. Dx in Oct .06 with Chronic Hep C. Biopsy showed Stage 2 Inflammation and 3-4 Fibrosis. Biopsy was done in Nov ,06
I am Genotype 3a and my Viral Load in '06 was only 72,00 All easy to treat I heard.
I had a hematologist follow me this last year and she did a bone marrow to see if the platelet problem was coming from there. It showed I wasn't making any iron and without reading the whole report again I really don't know what else.
I do have a slightly enlarged spleen...have no idea yet if it has become any larger since last report in Feb'07 and also have a few gallstones. All of this isn't really abnormal with Hep C
I just had another viral load test done but haven't gotten the results.
I do know that when you receive packed platelets they only last for 8 hrs. The hematologist said the problem with doing that to many times is that it makes the body think you have enough and it stops producing it's own
I just heard about Neupogen last week. I also was told that a lot of people don't "bleed out" from low platelets until 10,000 (?)
I have had  bruising and my legs look worse than ever....don't even want to go there. I can deal with the body changes at my age as it is the least of my concerns.
This is an ex-nurse that feels totally stupid at times!!!!

[Bill1954]

Hi Sizzy;

I’m sorry to hear you’re having trouble. Can you tell us if you are located here in the U.S., and if not, where?

Most doctors now provide “rescue” drugs for low red and white blood values, such as Neupogen and Procrit. These drugs are considered a form of intervention, and can help a patient remain on full dose therapy, versus dose reduction.

Currently, there is not much available to boost platelet counts, however. Many experienced Hepatologists will allow a HCV patient’s platelets drop to much lower levels than say, cancer patients.

Tell us a little more about yourself and we might be able to offer suggestions.

Take care,

Bill