lab test results input please?

[jt57]

My GP is concerned about several things in my lab work:

WBC  2.2
LY  52.4  H
MO  13.0  H
GR  34.6   L
LY#  1.3
MO#  0.3
GR#  0.8  L
RBC  3.02  L
HGB  10.0  L
HCT  30.1  L
MCV   96.7
MCH  32.1
MCHC  33.2
RDW  15.2 H
PLT   67   L
MPV   9.7


I am not sure what all this means, but she is very concerned about my platelets.  Also, I have had some swollen lymph nodes, under my arm and in my groin.  She has run a Epstein Barr test (for MONO).  I'll know on Monday what that test means.  I am about to take my 8th shot on Monday.  So far, I am responding.  My  4wk load went from 10 mill to 3k.  Pleased with that, but do not want to reduce any dosage, if it can be helped.  I am feeling very tired, weak, shallow breath, would love oxygen like Natalie Cole!!!!!  GP is thinking I need platelets.

Comments please!  I don't even know what some of these abbreviations in my test results are referring to.

Jean

[jt57]

I agree.  My GP is not planning to do anything without consulting with my specialist, but she is having trouble getting him to call her back.....

I really hate to have to change specialists, but I don't even get to see him much.  My appts. are the NP only.  I am not even sure if the Dr. knows the status of my condition.

Is this the norm with these guys?

Thanks for all your input.

Jean

[jmjm530]

This would be unacceptable to me. Due to the nature of this treatment, decisions often have to be made between appointments.

Have you spoken directly to the doctor about the problem? Sometimes -- and I'm being a bit charitable here -- the doctor isn't aware that someone has isses that need immediate attention, as NP's sometimes don't pass things on. The liver specialist really has to be made aware of a potential dose reduction by your GP -- only your hepatologist should order that.

The other point is that your GP should be able to get through to the liver specialist even if you can't -- professional courtesy or something like that. Can't you push your GP to contact the liver specialist re the blood results? If you're going to work with your GP, I'd be quite clear that he should contact the liver specialist right awayif he has concerns. Not to wait for a scheduled appointment.

If none of this works, trying to find a more responsive hepatologist is quite reasonable. "Well-known" is not good enough if not well accessible.

-- Jim

[jt57]

what is "CMV"?

Thanks

Jean

[jt57]

I do have a hepatologist.  My GP is monitoring my thyroid, which my hepatologists seemed to want her to do.

I have to say, my hepa is a very well known, good liver specialist, but he is not very accessible and his support, nursing assistant, pa, are not the most responsive when needed.  It is hard for me to get any answers from him and his staff, unless I am there on a "scheduled appt."  

I ended up in the emergency room on my birthday due to severe dehydration, and the fact that I could not get a call  back from my specialists.  I called my GP, and she told me to get to the emergency room. Since then, my GP has been monitoring me regularly, and my specialists just has me keep my "regularly scheduled" appts.  every 4wks now.

And I do have to say, my GP is the one who found my hep C, and she has been very supportive of me and my situation.  I have had some insurance changes and she has been the one to get me up to date on all meds, physicals, etc. before this change takes place.  She stays in touch with my specialist, or should I say, she trys to.  So it is not that I am not in the care of a liver specialist, I am.  He is just a busy man, I guess.

[jmjm530]

The point which appears to be lost is that she should be having these labs looked at by a hepatologist and not a GI, and that includes the platelet issue as well :)

[CoWriter]

Sparrow is right.  It's not about the platelet count and being able to stay on treatment.  It's about what's causing the rapid drop.

Look at the differential. Her lymps are high and she has swollen lymph nodes.  Could be mono, EB, CMV.  

[CoWriter]

She said.....

" I go next week to my hepatologist to have my 8 wk viral check as well as every thing else."

so she won't be needing a referral to a hepatologist....LOL

[jmjm530]

Without commenting one way or another on your statement,  I made it clear that she should check out Dr. Dieterich's exact words in the professional forum. Most important, we both seem to agree that a GP is probably the last person you want reviewing labs when you're on treatment.

-- Jim

[CockSparrow]

Jim its not the absolute number of platelets that her doc is concerned about.
More how fast they have dropped. 251 down to 67 in 4 weeks is quite a drop.

I am inclined to agree with you on seeing a liver specialist.
CS

[jmjm530]

If I wasn't clear above, if at all possible get a referral to a hepatolgoist (liver specialist). They can usually be found at your larger teaching hospitals.

The last thing you want is for your doctor to reduce your medications if it's unecessary. Sounds like this is likely to happen soon because of your doctor's inexperience both with reading your platelets and not administering the helper drug Procrit early enough.

[jmjm530]

GP is thinking I need platelets.
-------------------
Two things wrong here. First, you're having a GP evaluate your blood labs during treatment. In general they are not experienced or competent to differentiate what is normal and what is not during treatment. You really should be seeing a liver specialist (hepatologist) or at the very least, a gastro with a large Hep c practice. From memory, Dr. Dieterich -- or resident liver specialist -- doesn't get concerned about platelets until they reach 25, but please check the expert forum on that. I do agree that you probably should be getting Procrit (epo) at this point. Again, a liver specialist probably would have had you on it by now.

[jt57]

We are checking twice a week now.  My GP is really , really concerned.

[CoWriter]

Talk to your doctor about prescribing Procrit to get rid of the anemia.  

Platelets don't usually drop that much so quickly.  Sometimes the platelets get clumped together and a bunch of platelets are counted as one....so the first thing your doc should do (before he orders a platelet transfusion) is check the platelet count again.  

[jt57]

I don't know my iron levels, as of now.  I know what they were in the beginning, but I did not get copies of the other tests.  I need to start doing that.  I go next week to my hepatologist to have my 8 wk viral check as well as every thing else.  My GP is wanting to go with giving me some platelets.  I don't know what my hep will say.  Any advice on what I should maybe push him for?  He seems to not get too concerned about things.  Maybe he sees so much of it, he is desensitized.  i don't know.  I just know how bad I feel and it is overwhelming thinking I have 40 more weeks to go.......

Jean

[CockSparrow]

Ok an HGB drop of 3.7 is quite a drop and that alone could make you feel in need of oxygen. An hgb of below 12 is anemic and below 10 severe anemia.
Just so you know below 8 is transfusion territory.
The good news is that it should start to level out shortly.

I can see why your GP is concerned about your drop is platelets.
As a matter of interest what is your Iron level

EPO = Erythropoietin
Brand names for Epoetin alfa are (Epogen/Procrit),
and Aranesp for Darbepoetin alfa

EPO stimultaes red blood cell production.

btw Swollen Lymph Nodes can occur on Tx. I had them in the first few weeks at least.

CS

[jt57]

I now have the CBC tracker,  Any comments I would appreciate!!

[jt57]

also, showing my ignorance, but what is EPO?

[jt57]

ok.  baselines

WBC   5.4
LY  29.7
MO  5.3
GR 60.2
LY# 1.6
MO#  .3
GR# 3.3
RBC  4.67
HGB 13.7
HCT 40.1
MCV  86
MCH  29.3
MCHC  34.1
RDW  13.9
PLT  251
MPV  9.3

Thanks so much for your help!!

This can all be so confusing....

Jean

[jt57]

Thanks for your comments.  I will get my baseline levels and maybe you can give me a better idea.  It will take me a few minutes to pull those out.

Jean

[CockSparrow]

Baseline VL= 10,000,000 = 7 log
4 week VL  = 3000 = 3.48

You have had a 3.52 log drop in 4weeks, so yeh you should be happy.

As for your bloods you are Anemic. Without your baseline bloods cant say how big a drop in Hgb you have had. But at 10 its no wonder you feel like you need oxygen.

Your Platelets are low but can still drop some more.
Once again be good to know what your baseline was.

I’d be concerned about your Anemia at the moment.
If you cant get EPO you may have to drop a Riba pill shortly.
But your platelets will need watching.

All the Best
CS