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

[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.

[cougareyes]

Regardless of how you calculate it with your neutrophil % at 25 it is low. When my wbc was at 3 and my neutrophil % at 35 my doc said don't worry my anc was at about a 1000. Im not sure if they do a seperate blood test to get the anc(when listed seperately on the cbc), and some docs just use this as a guessimate.
Jim's right there is nothing in your bloodwork that warrents riba reduction, unless there are other factors that your doc is looking at. Especially this early in the game you don't want dose reduction.

[GoofyDad]

Spoke to the lab receptionist. She thinks bands (and segs too) are soemthing they only see for manual diff (hand done with slide) vs. auto diff (el machino). So lets at least assume I have bands > 0. That alone is an improvement. I'll try to learn more about deriving ANC from nurse and let you know what I learn.

[GoofyDad]

I treat at CPMC. I just stumbled accross this, which shows me as a Neupogen candidate based on pure WBC decline from baseline (3.7 to 1.9).

http://www.cpmc.org/advanced/liver/physicians/hepc-protocol-santacruz.pdf

Not quite a 50% drop for me, but given that it's so close so quick, I'm comfortable with a little early intervention.

I would like to get a handle on the ANC though. I'll persue that.

Goofy

[jmjm530]

Just don't take the Neupogen until you know your ANC. If your lab is only showing neutrophils and WBC it's possible you need another test for ANC. Don't really know. I'm also taking the purple pill -- two a day -- for GERD. The nausea you speak of us very common in the beginning of tx and usually gets better.  

I'm a little confused why they're talking about eventually reducing your riba as your Hemoglobin is 13. The only reason you should consider reducing Hgb is if you're anemic and Procrit intervention doesn't work. They're a number of drugs that can treat riba-induced nausea which like I said usually goes away eventually. Reducing riba, especially early in tx, reduces your chance of SVR.



-- Jim

[GoofyDad]

The lab is just showing Neutrophils and WBC. A few posts up in this thread I asked for guidance on the calc. Hopefully I'm doing it wrong. That would be good news. Neupogen won't arive until next week sometime.

I spoke with the nurse and she has sold me on nausea being triggered by riba pills. They're presribing a 'PPI' (like the little purple pill she says) to help with nausea and as a prophy for other stomach ills stemming from,low plateletes. I thought nausea was from food, but it's true, I eat, then I take riba.

She said they'll prolly reduce my riba at some point (remember me on the scale, Jim??...sorry hope you're not eating) but want to keep me at max for as long as they can. Sounds like they're right on the same page with me.

Just saw your new post Jim, I'll have a look at the calc. My old lab used to show absolutes, now I go to the hospital just cause it's convenient (believe it or not).

[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

[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

[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

[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

[cuteus]

what an odd thing this tx is! ANC so low in only two wks! WOW!
mine held above 1000, for most of the tx, until wk 65, then it dropped to 850, but went back up on its own. What individuality can do for numbers! The hgb did suffer through out, but normalized 3 mo post tx.
Hope all of your bone marrows hold on, for those of you treating.
Scott had some trick about taking the Neupogen at a time when the bloodword would show a good response, but I can't remember if it was the day before bloodwork or what.

[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.

[FlGuy]

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

[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]

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.

[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.