what do the numbers mean???

[baby T]

my test results on the PCR test was 9850 what does this mean if you can help out on this one please do. a nurse told me that it would take 6 months to a year for me to even get on the waiting list for this. is this true thank you again trisha

[GoofyDad]

Well I did start out a few cards short of a full deck, few bricks shy of a full hod, whatever.

In any case, I have the Neupogen & I'll start tonight. We were going to wait for another CBC on Thurs, when I mentioned my concern to the nurse about having a hip replacement in my twenties. The nurse called right back, Uhh the doc say start right away..... let's not wait for the CBC...

[friole]

I sort of missed this thread until now.  I am actually amazed at how low your ANC got on that second CBC and I think it is good you are getting on the Neupogen.  I do think your calculations of ANC are correct.

I think we almost have to rely upon the doctor's advice for the WBC drops. (I say that even tho I disputed my doc and did not take it when she wanted me to) With the hemoglobin drops it is so obvious to us because the anemia generates such visable side effects.  However, we don't really feel the drop in ANC -- but with that drop our bodies can be much more prone to infection. With winter coming on it certainly can't hurt to try to build the system's defenses.  There is an increased risk of infection in cirrhotic patients as the neutrophil counts drop (according to an article by Clinical Care Options, LLC) thus your doc is right on target by starting Neupogen sooner in those cases.

Personally, my ANC seems to be stabilized at about 1000 - 1100 (at week 12).  I never picked up the Neupogen at the pharmacy although I considered it, just to have it on hand in case. I will get another test this week and see how it is.
Kathy

[darcar]

hi all..
question about hepatic panel profile blood tests.
total protein is 8.2 ..normal is 6.0 - 8.3  so this is borderline.
albumin is 4.3..normal is 3.5-4.9 within normal limit range.
globulin is 3.9..normal is 2.2-4.2 ..within normal range
bilirubin total is .53 birn us .2-1.5
bilirubin direct is .11...norm is .00-.30
alk phosp. is 85..norm is 20-125
ast is 85 ....norm is 20-125
alt is 34..norm is 2-60
platelets are 167..norm is 140-400
===============================================================
im concerned about the protein, albumin, and globulin levels..because they seem very close to the upper range normal limit.
the pcr is 403 with peg / riba treatment.
any feedback ..appreciated and thanks.
DarCar

[jmjm530]

Re the Aciphex. It needs some protein to activate so take that into consideration when you eat your meal after.

[jmjm530]

Try to take the riba with at least a moderate amount of fat if you can tolerate. It should help with the nausea and will also facilitate riba absorption. Forgot what week you're in but riba associated nausea usually disappears later in treatment. Meanwhile, if it gets really bad there are drugs like Zofran which can help.

-- JIm

[cougareyes]

Yogurt, fruit, and maybe an english muffin is all I can down in the morning. My appetite seems to get better as the day goes on.
Good Luck

[GoofyDad]

Thanks Jim. My nurse emailed that they use the simple calc too. Their guidelines say Neupogen at 500-750 for stage 4; otherwise they'll go down to 250-300. I didn't bother to ask why stage 4 requires earlier intervention; there are certain things I probably don't want to know.

They'll test me for b12 and iron stores next week. I'm really happy with these folks. I'm soooo glad I waited & got into them before starting tx, even if they did sentence me to 48wks instead of 28. No way I would have this access & this care level with the former GI.

Oh, any tips on the nausea from my morning riba? I was eating a cup of good yogurt each morning, but I need to get more. I just started on daily Aciphex, hopefully that will help. I don't know what I'll do if the riba doesn't stay down one time? I don't want to miss a dose of this lovely stuff!

[jmjm530]

I just looked at my labs again and realized besides calculating the ANC, they also give total Neutrohils%. Your ANC calculation appears to be correct then. What threw me off was the fact that your WBC was higher than mine but your ANC was lower. That's probably why a number of docs, including mine, are mostly concerned with ANC and not WBC.

But with the blood roller-coaster you've been riding, you still might want to do a blood draw a few days before the Neupogen arrives. Both times my ANC approached 500, it jumped over 400 points the next week.

Concur with Cougar about the riba. Try and hold onto the higher dose as long as you can. Use Procrit if necessary. Higher riba levels are associated with higher SVR rates.

-- Jim

[FlGuy]

For my schedule do the peg Friday evening, CBC Monday AM.  riba has a half life of 44 hrs but with daily AM+PM dropping it's at a constant level.  Peg has a half life of 27 hrs. So, i figure that by Monday am (60 hours) the peg has had it's max effects to the CBC. But with work and kids have to stick the the schedule I have.  Would prefer the CBC later than Monday but gotta do what you can.  Looking forward to not having track marks - again.  With the peg, insulin, glucose reading, neupogen I make 16 holes a week.  Thank goodness platelets are not too low, I'd be leaking like a sieve.

[jmjm530]

The number to be concerned about is ANC (absolute neutrophils) not WBC.

If your ANC is above 500 you don't need Neupogen yet. I believe H. Hoofnagle and maybe others did a study that showed no increase in bacterial infections on HCV treatment with ANC above 500.

In my case, my ANC was in the 1300-1500 range for most of treatment. About six weeks ago it dropped to 800 then the next week back up to 1100. Then two weeks ago it dropped to 600. Then last week up to 900. In other words, unlike with hemoglobin, a decline in ANC is not always linear. My WBC has been as low as 1.4 and my doctors weren't concerned.

-- Jim

[FlGuy]

Both neupogen and neulasta (pegylated version of neupogen) work fast, unlike procrit (EPO) which is more gradual effect for the reds. Didn't notice any sides with neupogen but neulasta gave bone pain (back and legs) for a couple of days.  ANCs decrease fast too.  I get 'pogen or 'lasta every 3 weeks or so now.  Lot of stuff works on your mind, but I think the 'dragged' out feeling is helped by the neu's.  But, then again, I'm in a fog anyway.

[cougareyes]

You may also consider when you draw your blood in relationship to shot nite. They say the interferon may effect(lower) your ANC and WBC up to 72 hours after your shot.   Peace

[jmjm530]

I wonder then what night in the cycle the studies use? I always try and draw blood on day "6" -- the day before my shot night. That gives me a conservative "trough" value at least for my PCR.

-- Jim

[GoofyDad]

Thanks guys. I'm drawing labs on day 5, since that's a Thursday & it gives me a day of wiggle incase I forget or the surf's up on Thurday leaving me with Friday open (yeah, right). Yesterday the fellow at the lab took like 9 vials, when I said that seems like a lot. Oooops, wrong draw sheet. "Well shove 'em back in dude, I'm low enough already", LOL!

I was dragging butt yesterday, though still able to get to work to sit on my FA there instead of home. I seem to be doing better today. Nurse's first email yesterday said she thought they'd be looking at doing something for the RBC's, then Dr checked in and said he was going after the WBCs/ANC. Hopefully this is just that 2 week dip, and my counts will start improving, toot suite (like that veggie?).

I still don't have the recent labs, but using baseline as an example, do I have my calc correct?

3.7 (WBC) x 36 (Neutro %) =  1,332 ANC

Thanks again friends. You're a huge help.

[GoofyDad]

Well I found fiole's thread from a month or so ago, which put forth the usual well reasoned opinons & debate. I should have looked first. Now, I just need to get my ANC #s tomorrow & I'll better understand where I stand. Given my baseline, it doesn't seem this should come as a huge surprise.  

Kathy (friole), you made a point of going back and adding a follow-up on your progress to the old thread for archival and I want to thank you. Very considerate and helpful.

Now, back to your regularly scheduled thread-jacking.

[FlGuy]

Your calc for ANC looks right.  BTW, Neulasta effects on ANC. ANC's were 653, got Neulasta, following Monday ANC=9428, following Monday ANC=2916, following Monday ANC = 2176.  See what happens this Monday.  It's an elevator ride.

[GoofyDad]

Got my CBC from yesterday. WBC 1.9, Neutros 25, Platelete 81, and hemo is 13 from a baseline of 15.5 two weeks ago. By my calc ANC is a whopping 475. It's confirmed, not only do I look crappy in real life, now I look crappy on paper too!

[FlGuy]

Time for neupogen/neulasta.  I find that the swings in WBC/ANC lot more volitile than hgb and plats.

[GoofyDad]

Any hope for the Neupogen to help with not feeling so great? Fatigued, bit light headed, and a touch of nausea... that's the one that get's me.

[GoofyDad]

Thanks Cougar. The Neupogen is on its way. Sorry for confusion on riba reduction. Based on weight, I'm actually overloading right now, and they want to run with that for a while. They expect to reduce at some point, but by then I should be well  inside the guidelines.

[jmjm530]

How are you calculating ANC? I'd double-check the calculations wth your doctor or lab to make sure. My most recent ANC is 975 and my WBC is lower than yours at 1.5. My understanding is that a WBC of about 1.2 or 1.3 would correlate with an ANC of 500 and your WBC is 1.9. The rest of your numbers look OK.

-- Jim

[painintheside]

Hello,
I seen the other posts about your stage. I am a stage 4 and they haven't even considered putting me on a transplant list. I go up to the Cleveland Clinic so I feel assured they are correct. And stage 1 or 2 aren't even considered cirrhosis...not until stage 4.

Go see a different doc! Sounds strange to me. I hope you do well with tx though. I just started tx (had 2 shots so far).

Sincerely,
Dana

[cougareyes]

I believe they used a calculator because their neutrophils were listed out as a percentage instead as absolute. On the janis website there is an expample. wbc x neutrophils % = anc
That is how mine are listed also.   Peace

[jmjm530]

The formula I found appears to be a little different. It is possible that Goofy may need additional bloodwork to calculate his ANC. With Quest's CBC w/diffentials, for example, it's already calculated for you. I just want to make sure he's reacting to the correct numbers as his WBC doesn't look all that bad.

(Neut + Bands) (WBC x 101) = ANC

Complete article for calculation with examples:
http://www.curehodgkins.com/hodgkins_resources/determineANC.html