WBC Decrease - for those in the know ??

[sllowe]

Hi all,

Putting this to all of you for thoughts.  The Dr. just called me and said my WBC count was 2.7 which is low as the range is 4 - 10.5.

I'm on Rebif, so I was just tested.  My thyroid and my liver enzymes are just fine.

He said to me (on the phone) right after he said it was low, "copax does not cause any of this." I told him I had a wretched virus for the better part of 2 weeks and was on antibiotics, and then asked him if this would affect the test.  He said well we can re-test it in a week or two.

Wouldn't WBC's be high during a virus or infection?  I know there can be many causes to low WBC other than meds, and the test could very well resolve next attempt, but I still wanted to share with you all, so you can send your thoughts with me.  

My CBC's were fine the 1st time around on Rebif, which was a little over 5 months. I'm just about at the exact place in time I was then (little over 5 mnths).

Send me whatcha got!
Thanks,
shell

[sllowe]

Thank you so much Oh Not Popped due to being over Pooped One....ha/ha.

Thank you Doc Q and all who pitched in here.

Hope your weekend is peaceful and relaxing.

Shell

[Quixotic1]

Hi, Shell, yep, I am too pooped to pop after looking at flooring for three days.

You took the math one step too far.  I calculated your ANC -  Absolute Neutrophil Count - as 1080.  That was actually given (I understood) on your report - It was the 1.1 x 10E3

To recap it sounds like your total WBC was 2700

Your Neutrophil percentage was about 40% - that's low.

To calculate the ANC to multiply the percentage of neutrophils times the total white count.  2700 x .40 = 1080

Answer - you are at 1080.  This is low, but not in the danger zone.  I would advise you - in the absence of word from your doctor, to skip your Rebif until you know the repeat CBC results.  In cancer chemo or in the immunocompromised, at an ANC of 500 or less great precautions are taken.  If you get a fever (any temp over 100.4) or symptoms of an infection before you know the results of your CBC you should seek medical attention and make sure they check your CBC and recheck another CBC, get blood cultures, urine cultures and a throat swab.  If you have to go to the ER, then wear a mask and ask others to take heightened precautions.  Most docs working out of a hospital know this stuff.  Stay away from crowds and don't kiss anyone.  Yes, I know it's Easter.

I doubt that you are in trouble - just trying to give you some guidelines.  The cause might have been the virus, but things that "can" suppress the marrow sometimes work in synergy with each other.  One cause might ding the marrow a bit, but, added to the other cause, it can give it a wollop.

Take care.

Quix

[sllowe]

I went to the lab today.  They said results would be faxed to the Drs office the weekend.  You know they'll not call me the weekend though and let me know.

So, based on the recommendations and not knowing if the count is still low, I should skip my 3rd? If so, that would make me due this coming Monday.  My appt. is not until Tues and I don't anticipate hearing anything from the Drs office on Monday.  Just is what it is w/them.  

Anyone know if the math is good above? Doc Q may be pooped from shopping. Bio?

Thanks,
shell

[sllowe]

Ok.  I'm going this a.m. I injected this past Wednesday.

Thanks, Jeannie (does say x10.E3).  Based on what you gave me, this is what my baby boy says:

1100 x .4074 (074 repeating) = 448.148 (148) repeating/repitand bar

Does this mean that when I had my blood drawn that my ANC = 448?
If so, that puts me in the danger zone.  I injected on Wednesday, durrnit.  

I'll not be injecting tonight - I'm on my 72 hr stretch anyway.  I know today's results will not hit my Drs office (it's safe to say, so I'll assume he's not concerned enough to call them) until Tuesday when I have my appt.

Austin really needs to be a scientist and cure us all of MS! He's watching me typing this and I really don't know if he realizes his brilliance!

Oh, and I'm up for suggestions where lab results are concerned.  I don't believe they would give them to me w/out my Dr office getting them 1st, like the imaging facilities would.

thanks,
shell

[Quixotic1]

1.1 total neutrophils would be 1100, Iif you check the units of measurement you will see that it is somerthing like 2.7 (x 1000 or 10 the the third power)

So you have a significant, but not yet dangerous neutropenia.  I belive that the rec at this point would be to hold on the Rebif until the count cam back up.  Continuing would be foolhardy.  I tried to look up the actual rec, but didn't readily find it yesterday.

You have been taking the Rebif all along, so we have already taken the foolhardy approach.  what you need now is another CBC before you take another dose.  Can you get your PCP to order it?  If you got it in the am you would have the results in time to take the Friday dose or take it Saturday.

[sllowe]

All -

Trying to do some math, but my kids are the masterminds w/numbers.  I have my printout and it appears that the neutrophils (absolute) make up 1.1 of the total WBC count which is low at 2.7.

So, based on the formula our very own Mastermind Doc Quix provided in this case, who wants to help put together the equation?

1.1 is less than 50% so I'm thinking is would look something like this:
                            .3 or .4 x 2700 = 1080

I know some here like puzzles - Did I get this one wrong?
As always Doc Q - thank you so much. Like you say, I'm not at severe risk unless it is indeed dropping.  I've got my script and will have it re-run today or tomorrow a.m.

Who else wants to take a crack at this?                            

[sllowe]

bump for Sunny-B

[Quixotic1]

I'm going to be out for the day doing mandatory shopping for the flooring in the basement.  You get the absolute neutrophil count by multiplying the percentage of neutrophils times the total white count.

So if neutrophils make up 50% of the count then 0.5 x 2700 gives you 1300.  That is low, but not dangerous.

Yes, I think they guy doesn't like the hassle of dealing with the problem and is going to suggest Copaxone.

Q

[sllowe]

Also, I will get my hands on the lab report so I know the 2.7 is in reference to...

[sllowe]

Essy - thanks I was thinking too -  what the heck kind of loop this virus threw on me  and what can cause what type of reading, etc.

Opie, good luck w/your testing.  Ask them to add thyroid to that - it's something they suggest to run too w/interferons but I've always had to ask my Dr.

Lu - thanks for your concern

Doc Q - I had to suggest to him to re-run the test and then I followed that up with ...I have an appt. w/you next week, I can get the script then.     I'll take your suggestion though and call and get that script this week since I was tested early last week putting me into the 2 week too long mark.

No, was not advised to stop the Rebif. Was told about the low WBC and then next was advised that copax does not cause these sort of things. Maybe he's leaning toward it as a culprit (without coming out and stating it), but I'm not convinced since I've tested good in the past.

Thank you all so much for your thoughts

[Lulu54]

Shell,
I'm sure glad Quix earns her pay here and was available to answer you!  I know you will listen to what she said and follow the advice to the letter, right?

Concerned, but not worried yet,
Lu

[Quixotic1]

Typically viruses send the White Count up in the first day or so, then send it low for the duration of the infection.  2,700 is very low, but some virus, like Parvo do that quite easily.  It also could be an additive effect of a virus and the interferon.  So his counsel to recheck makes sense.  However, 2 weeks is too long.  I want you to get it rechecked it 5 to 7 days.  If it is dropping, 2 weeks is too long to let it drop without a check.

Now, 2.7 is probably not dangerously low.  What you need to know - now - is what your absolute neutrophil count is.  the point that we start taking real close note is an absolute count count of 1500.  But at 500 you are immuno-compromised.  You can't respond (fight off) infeections adequately and need to start wearing a mask - not going outside, etc.  If you are at an absolute count of 1500 neutrophils  or lower I think the protocol is to stop the Rebif and recheck very frequently.  I will look into this.

Are you supposed to continue the Rebif?

Please get your CBC results and recheck all of this.  Okay?  We have seen too many doctors that were laissez faire with stuff like this.

Worried, Quix

[opie74]

Shell,

Iam on monthe 3 of Betaseron.  I am due to have my cbc, count, and liver panel next week.  Let me know what you find out, and I will do the same.

[essdipity]

Hi, Shell. What I got ain't much. Could the antibiotics have caused overkill? You were really sick for quite a while. I'm not surprised your blood chem. is out of whack. At least you know you're well now.

Please don't read anything sinister into this. In a week all may well be normal. Hang in there.

Hugs,
ess