low WBC

[chitch]

Low levels of WBC 2.2 The doctor wants to lower  pegasys dose and has not mentioned anything about Neupogen as an alternative. Taking another blood test in the am but uncertain about the lower dose of pegasys and the if it will actually work. Ribivarin is the co pilot if you were wondering. My third week is Friday.

[chitch]

Thanks for pointing me in the right direction I will be sure to ask for all of the above and to question the ANC before the deciding factor is determined.

[Trinity4]

Bill is correct, it's the ANC that should be the determining factor as to whether  intervention with Neupogen or dose reduction is necessary.  ANC does bounce around but in the case of a steady decline with no upswings Neupogen is necessary.

If the ANC drops below 500 most doctors get concerned but some aggressive hepa's will continue treatment even when it drops below 500.  However, Neupogen should be considered when the ANC reaches continues to drop.  Different doctors have different thresholds.  My doc put me on Neup when I went below 600 and it rebounded after several weeks.    

Trinity

[chitch]

Thanks :)

I will ask.  and have not had very good luck with the whole doc environment. As the prcess started and the office errors occured the doc approvals, spec pharm and ins,approval was in process the meds started and It didn't seem like a good option to switch it up at the time...for numerous reasons. That;s why Im here.

[Bill1954]

Here’s a link to an ANC calculator; sometimes the calc isn’t provided by the lab, but the other fractions should be:

http://www.mdcalc.com/absolute-neutrophil-count-anc

Bill

[Bill1954]

Welcome, by the way :)

[spectda]

Do you have a copy of your cbc?

[Bill1954]

Okay, it should be listed in the CBC, in the section called 'differential'. It can be calculated, but requires other components from the differential.

The cutoff for intervention (ie dose reduction/neupogen) is around .50.

Ask the doctor or nurse for a hard copy of the labs, and someone here will help you interpret them, hopefully.

Good luck--

Bill

Bill

[chitch]

I do not have the absolute neutrofil count, and am fairly new at this, I will be sure to ask about it on our next conversation (Thursday) after the second blood test.

[Bill1954]

The value of absolute neutrofils are often used to gauge when to intervene; do you have these results also listed in the CBC?

Bill

[spectda]

Your doctor sounds like they may not have a lot of experience treating Hep C, I may be wrong. I believe a good experienced aggressive hepatologist would do nothing with your meds right now, monitor closely and give neupogen to you if it gets too low. How is your absolute neutrophil count?
- Dave

[jt57]

I agree.  You arent critical at this point.  But if you get below 2, insist on neupogen.  Do not reduce the pegasys!  Especially so early in the game.  You want at least 12 weeks at full dose...

Good luck,

Jean

[pcds]

My WBC went to 1.7 which was a critical value.  I don't think 2.2 is critical.  This happened to me at 2 or 3 wks into tx.  Options discussed were decrease riba or take neupogin.  We decided on neupogin.  I would insist on it actually.  I started at 2 shots a week and my WBC went up to 23.  Then did once a week and I was OK.
Judy