abnormal labs, possible infection...reason for concern?

[hopeful587]

Just retrieved a phone message from my Dr's asst. from early last week that I had some abnormal 24 week lab results and that he would like to see me a week early. Last Monday I stopped by the lab and left town.  I called in on Thur. and was asked to come in for another blood draw as soon as I get back...didn't know that there was any problem.  Usually have results faxed to me.   So this news was a surprise to me tonight.

My concern is that I started having sinus and throat issues last Thur., ears are a bit achy tonight.  I am still out of town.  How concern should I be about infection?  See Urgent care clinic?  Start antibiotics?  Don't want to overreact, but would rather err on the side of caution. Never like making decisions w/o all the facts. Hgb, anc, and wbc have been low as I have previously posted.  But have not started procrit/neupo.  Praying I have not become interferon resistant.  VL was still 71 at week 18, but had had over 2 log drop by week 12.  Thanks for your input, Y'all have helped me through some scares and I going to continue to trust God to guide and provide.

Hopeful587

[newleaf09]

low hgb, anc, etc. does not mean interferon resistance so don't worry about that.  low means the chemo is whomping your blood.  A random clinic will be less effective at figguring out your care with the chemo involvement.  Call your doc and ask exactly what it was that alarmed him and take his advice.

[mikesimon]

I wouldn't immediately think of "infection" under these circumstances. I am not suggesting that you couldn't have an infection but simply that I wouldn't think that would be the reason for the message.
I have read that interferon induced neutropenia is not as likely to result in infection as neutropenia generally is. I also think that if it was a serious infection then something more would have been said about it - the message should have been more urgent. I think that the fact that they simply told you they want to move your labs up a week early doesn't suggest a concern about infection.

I have this from 2006 but I have seen similar statements more recently.

"In addition, the lack of association between constitutional and peginterferon-induced neutropenia and infectious AEs suggest a lower ANC threshold for peginterferon dose reductions might be safe."

Peginterferon alfa-2a and Ribavirin for Chronic Hepatitis C Genotype 1 Infections in Black Patients: Safety, Tolerability and Impact on Sustained Virologic Response

http://www.medscape.com/viewarticle/533574

My advice is call your doctor's office and get some more information if you are really worried. And go get your labs drawn ASAP.
Good luck,
Mike

[newleaf09]

If your ANC dropped very low, it makes you more susceptible to infection, especially bacterial infection.  I believe that there is bacteria naturally occurring in the body and for some of us, when neutrophils decrease, those bacteria are no longer held in check by the neuts and begin to proliferate into sinus infections, sore throats, kidney infections, etc.  It's the interferon that is accidentally destroying the neutrophils (common characteristic of chemo drugs), so your docs are watching that carefully.  

My TX team started to get alarmed when my neutrophil count dropped below 1 and, sure enough, when it got down to around .6, I got a miserable kidney infection.  Broad spectrum antibiotic cleared it fairly quickly and a shot of Neulasta (Neupogen is the same thing) brought the neutrophils back up into a safe range.

TX really beat my blood up.  Had to have neulasta 3 times and was stopped for 4 days when we could not find the Neulasta in town and had to wait for it to come in.  Remained UD throughout the whole peg/reduction, Neulasta rescue business.  I recommend that you do whatever your docs tell you to.