WBC count too low. Doctor says to stop treatment! It's my choice to make right now...

[cieritaqt]

What do I do? My doctor is on vacation, and the on call doctor says to NOT DO my injection #3 tonight and stop taking Riba. My white blood cell count is 400, or 2.5, not really sure what the difference is, but it is low, and I am at risk for infection, basially have a low immune system. Anyway, I have my injection and Riba on hand, and I can either take it through the weekend, or stopp all TX and go to see my specialist on Tuesday and see if she will start me back up again. I feel great, I am so mad, and confused. Should I go against doctors orders and continue TX? What would my doctor do? I am on day 14, this is not fair. Please someone post something tonight so I can make my final decision. I'm so torn and indecisive.

[lynda607]

People on HCV antiviral therapy who experience Neutropenia are not as susceptible to infection that those on cancer chemotherapy although 400 is very low for ANC  Most hepatologists don't become concerned until the ANC drops below 500 but as you indicated latent TB could be a problem. You could split the difference and do 1/2 a shot.  I don't understand stopping the ribavirin unless your hgb is low too.

As info, Neupogen is very fast acting and usually works within 24 hrs.  If your ANC is this low at the 2 week mark, you are going to need Neupogen to sustain your treatment.

[crossroadsec]

I'd be bargaining for 1/2 dose. I can't type well right now. Sry you've had such a ruff decision. Let us know. You'll be good. I've been on 1/2 peg for 3 weeks... Hang in there.Karen

[OdinLovesLife]

I am off to bed now. It is late here. I am sure oher people will start giving you lots of support soon.

One last thought. Can you ask your on call doc to call your principle doctor for advice? Maybe the on call doctor would be able to prescribe the Neupogen after a consult. Also
1. ask for an explanation for why they asked you to stop
2. get all your numbers.
That will clarify whether or not your on call doc is just being overly cautious or if there are good reasons for stopping which you should not ignore.

You will be OK. Best wishes to you.

[flcyclist]

So sorry to see you with this difficult decision to make.  If it wasn't for the latent TB, which I know nothing about, I'd be leaning toward doing the shot and Riba.  However, putting you at risk of infection with this additional challenge sounds risky.   I agree with the others that if it is the ANC drop concerning the doc, then why drop the Riba?  My ANC often goes down to 0.3 on Monday, after the Friday Inf shot.  Neupogen 2x/wk brings it back quickly.   At this point I'd be very reluctant to do anything other than follow the docs orders unless you can convince him otherwise.  Good luck

[GINGERPAL]

just want to let you know that i am thinking of you.  it is not easy to be in a situation and not know what is best to do.   but whatever you did, was the best you could do.  i wish you well....ginger

[frijole]

"My WBC count was 400, and the doctor told me anything under 500 was dangerous. Another reading was 2.5, not sure if that is for neutrophils, I wish I had more information than "

I believe, from the numbers you are giving, that your white blood count is 2.5 and your absolute neutrophils are 400 ( or .4). They are low, but neither of these numbers are game breakers.  

The on call doctor -- it sounds like he is just trying to cover his a$$ - and I will go out on a limb and say he is not an expert in hepatitis C.  Yes, those numbers are low but they are not out of line, and IN MY OPINION you should not skip this shot.  If you skip the shot, before you are UND you could jepardize your treatment success.  The goal here is to do this once and get it over.

For a point of reference, my bloodwork at week 4 -- after the SOC lead-in for Victrelis -    My WBC is 1.7 and my ANC (absolute neutrophils) are 500 -- so overall, my WBC is lower than yours and the ANC is about the same.  This did not even merit a call from my doctor.  He is a hepatologist at a Liver Transplant Institiute and works constantly with hep C patients and has been involved in many trials.  

There is good documentation that patients treating for hepatitis C whose ANC drops below the 500 threshhold (severe neutopenia) are NOT at risk for infections to the extent that cancer patients are.  That is the heart of the matter.  Most doctors are much more familier with the chemotherapy criteria for ANC and infections than hepatitis C.

Since your ANC has dropped this fast you may have to take neupogen for the duration of your treatment.  Consult with your doctor ASAP.  He may have you take a couple of shots next week and level out to 1 a week after that.  Are you treating with a hepatologist or a gastro enterologist?  Do you think he is pretty savy?  Alternatively he may have you reduce your interferon level, but, again, push for the neupogen.  You are not UND yet and need to keep doing the SOC drugs if at all possible.

I am sorry I did not see your post last night.  If it were me, I would take the shot now.  As another point of reference, I treated for 56 weeks with SOC and my white blood count was under 2.0 for most of the last 44 weeks.  My ANC fluctuated and I did neupogen for that entire time.  I was only sick once during that time.  

Hang in there my friend
frijole