Low WBC, RBC & Platelet, should I continue treatment?

[kally291]

I was detected hep C last summer, seems I was infected by blood transmission when I was 3. I'm 23 and started my triple therapy Mar 29. So today is the first day of my 4th week treatment. Feel good during the treatment, less side effect. Only feel losing appetite and hard to finish 20g fat. I took my lab test this Wednesday.
I got the result today, it shows
HCV RNA, PCR Quant    not detec,
HCV Viral LOG               not detec.

But the WBC, RBC and platelet are abnormal, especially for my WBC.
WBC 2.1L    4.0-11.0K/UL
RBC  3.67L  3.80-5.10 M/UL
HEMOGLOBIN  10.8L   11.5-15.5 G/DL
HEMATOCRIT    33.4L  34.0~45.0%
PLATELET COUNT 99L   130-400 K/UL

Should I continue the pegasys injection tonight? I already contacted my nurse, but the phone call turned to voice mail. I read some articles, seems when having a low WBC you need stop the treatment. I'm just shock when I seen this, because I feel everything go through better than I thought before I start my treatment.

Sorry for my poor English, I hope I express everything clearly and offer enough information.

Really appreciate your reply.

[willbb]

Should I continue the pegasys injection tonight?
------------------------------------------

Absolutely!
Everything your blood labs show is perfectely normal for someone undergoing HCV therapy and  nothing there shows anything of immediate concern

The WBC and HGB ..is usually somewhat less  than normal for someone doing tx,however yours actually look very good

The plats at 99 are somewhat low and would be monitored by a good treating physician ,however again..not anywhere near the level of immediate concern ( lower than 50 many doctors would take action ,however many have been know to continue tx. as low as in the 20's)

Good luck the rest of the way and welcome...

Will

[kally291]

Thanks!!  
Your reply makes me feel better!!

[willbb]

The above poster covered it all  while I typed...

Will

[kally291]

Thank you Will.
From your number, I get kind of understand about the level I should pay attention to. I will keep tract with my plats.

[willbb]

:)

[ppmguy]

         your cbc is stable.   its low on platelets, hemo, and white cells, but does not look like anything to stop tx for
       btw,  congrats on being und at 4 weeks, thats huge.  keep on keeping on.  
                              barry

                  ps   always check with your dr

[kally291]

Thank you for your reply.

Is there anything I can do about my platelets and others? Or just let my dr know?

[jules2551]

Just to let you know my platelets got down to 31 and my WBC was always below 2 and they continued tx. Enjoy your shot tonight :) and Congrats on UND wk 4

[can-do-man]

Your platelets are fine at 99, nothing to worry about. As a matter of fact your levels show treatment is working quite well... A HGB at 10.8 on treatment is great also.........

[kally291]

Thank you!!! I was terrified by my mom, she keep mentioned a long list of food that can improve WBC. But when I ask my dr, he said he would not recommend bc the Incivek may have conflict with these food.

[ppmguy]

           hi kally,  i think you are doing very good on your therapy.  your tx dr  can lower your peg dose to 135 mcg if your wbc falls to 1.6... if your hemo falls below 10 your dr has options there also.  when my platelets fell below 75, my dr said "dont fall down".  yes, always let your dr know.  your rvr  is reason to stay on tx.  
                                        barry

[kally291]

I think I probably worried to much. Bc I feel a little bit sleepy when I step in the 3rd week of the treatment. Not like the side effect said insomnia. My dr said it probably bc of anemia. So when I get my lab, it shows abnormal, I was shocked.

[jules2551]

"your tx dr  can lower your peg dose to 135 mcg if your wbc falls to 1.6.."

************

Why on earth would you recommend that?

[ceanothus]

You can't do anything about any of those numbers. If they get severe enough your doctor might prescribe "rescue" meds that will help, or might suggest reducing the dosage of your ribavirin, but you are not currently near to those levels. Each doctor does things slightly differently, but to give you a better idea of the problem numbers, most do not worry about platelets unless they go below 50 (and then consider Rx Promacta or transfusion), most do not worry about HGB until it goes below 10, and some let it go as low as 8 before taking action (Rx of procrit injections or possibly transfusions), and most do not worry about low WBC unless the ANC drops below 0.5, and then consider dose reduction, Rx Neupogen injections, or stopping tx.

During tx my HGB dropped as low as  10.1, my ANC dropped as low as 0.6 and my platelets dropped as low as 0.51. My doctor ordered more frequent testing (weekly) each time something dropped near to the cutoff  line, but each time the numbers bounced back a little on their own without intervention. I completed 48 weeks of tx in Sept 2012, without any rescue meds or dose reductions, and am now SVR.

You can do it, just make sure you have frequent tests whenever the numbers drop very low, as not everyone has them bounce back on their own!

[can-do-man]

"Bc I feel a little bit sleepy when I step in the 3rd week of the treatment. Not like the side effect said insomnia. My dr said it probably bc of anemia."

I agree with your doctor. Soon this will be all over and your well on your way to being cured...:)

[Idyllic]

You are in week four and you are UND that is fantastic news :)
On the other hand

Errr...wait a minute just to be clear you started treatment 29 March and you say "I took my lab test this Wednesday."
That means
Friday, March 29, 2013
To and including: Wednesday, April 17, 2013

is 20 days.

3/29 week - 4/5   week 1
4/12 week 2
4/19 week 3
4/26 week 4
___________________________

This is interesting because you are young and presumably in good health (??) and while I would take my shot of Peg I have to say to me at this stage if your dates are accurate these meds are really kicking in.

Can you tell us more about your health and whatever else might matter? I would do my shot as well but I am wondering about your Peg dose and how you are feeling. The reason I ask is because over the next few weeks your values may stablise, gradually drop or plummet.

When I was on Incivek one minute my Hgb was 10.1 and I felt fine and the week after the my Hgb was 8.1.

[Idyllic]

I agree with all that has been said. I would just keep having the lab tests when you are scheduled and be sure your viral load draws are scheduled on the right dates.

I am glad you are feeling well.

[kally291]

Thank you for your numbers. These gives more conception about how low I can go. I think I have waste most of my time with my dr. Next time I should ask him how low he think I can go. :) Anyway, I feel good I'm UND and not very severe side effect. The only thing right now is finish the rest 8 weeks quickly and get rid of Incivek. The 20g fat make my stomach feels bad.

[ppmguy]

              i dont recomend dose reduction at 1.6. when i reached that threshold, i was told by tx dr that protocol is dose reduction to 135 and to do cbcs weekly until cbc is stable.  i had 2 dose reductions to 135mcg of peg and i am und for 14 weeks post tx.  so   protocal

                                   barry

[Idyllic]

Yes this disease can be very time consuming with the lab visits and doctor appointments and the three times a day you take the Incivek (as well as the doses of Riba). It helps to be organized.

It is a good idea to ask the doctor how low certain values on your CBC can drop and what will he do when they do.


For your WBC the value that it helps to know is the one called Absolute Neutrophils. It might say Neutrophils (Absolute) abbreviated as ANC. That number is used as a gauge rather than the WBC.

So (basically) your Hgb, ANC and platelets are the values to keep an eye on.

[kally291]

hahaaa~ No problem. Feel happy to share with you.

I think my health is in good condition. No smoking, drink little before detect hep C, since July 2012, I quit drinking. When I start the treatment feel less side effects. I think sometimes I feel hard to have 20g fat, bc I don't eat that much before I have the treatment. And I don't choose the right fat source. I feel I don't like peanut butter. Right now I'm having soup with 1 and a half tbs olive oil. Olive oil seems good for our health, :) and it can help lose weight. That's my motivation right now. My suggestion is start 20g fat food a little bit earlier than the treatment. Let our stomach have more time to adjust to new food diet. And choose the right fat source.  

But when I get my base lab test, the WBC and RBC shows close to the bottom line of the range. So that's why I'm very worried about the WBC.

About my does. I have peg 180mg, Riv 1000mg (600mg am,400mg pm), Incivek 2pills per time, 3 times per day( I believe it's 375,but I'm not sure, I will check after I'm back home)

I guess I'm UND so quick bc my viral loading is low. Bc my dr said my viral loading is low when last time I meet with him. If you are interesting I can share with you late after I'm back home.

[kally291]

I find Neutrophils on my lab, it shows 12.5 11.0-15.0%. This one is normal, I only copied the abnormal date. So from this one it looks good right?

[jules2551]

I think there are other factors involved before dose reduction is considered.  Congrats on your post UND!

Kally...do you have a Neu # on your lab report?  The range should be around 2.0 - 7.0.  This will be your ANC # and that would determine if you need Neupogen or not.