went to ER. new bloodwork questions!!!

[jt57]

You all know I have been battling my hep Dr. trying to stop treatment on me.  I went to the ER last night, because I was feeling SOOOO bad, and my hgb was at 8.6 on Thursday.  So I just assumed it was the anemia.

Nope.  I was severly dehydrated, again.  damn, I don't know how that happens!  Anyway, my HGB was at 9.4!!!!  went that far up in only 2 days!  And I did not stop my riba, like my dr. said to.   The platelets he was SOOOO concerned about, thinking I probably have the immune thrombyanemia thing, were up as well!!!!  from 53 on Thursday to 68 last night!

But my concern is my wbc and anc.   On Thursday , my wbc was 2.0 and my anc was .9.  Last night, my wbc was still 2.0, but my anc was .4.  

They also did  some platelet test I am not familiar with.  it stated "polychromasia 1+, Tear drop cells *Few, Large Platelets *Few, and Platelet Clumps *None Seen.  The polychromasia, Tear drp cells, and large platelets all had AB next to them, for abnormal.

Anyone know what all this means?  Should I push to start for drugs for the anc?  I really don't want to reduce interferon, and that may be what is coming.  I just don't know anymore with him.  But maybe the hemo I am going to see on Monday can help me, as well.

All thoughts and advice are appreciated!!!

Jean

[jt57]

You all make some very good points.  I have reduced my riba to 800.  I think it may help and at 115 lbs, I should be ok.  I am concerned about my hgb staying so low.  I did get the procrit...with the help of my GP.

I really appreciate the article of platelet antibodies.  That seems to be the road my hep is convinced I am going down.  I just feel that since my GP is monitoring him, he is being overly cautious.....and his NP isn't helping him any, or me.

I am drinking water ALL THE TIME>>>>>

took shot 12 last night.    Feel ok...just tired.  My son is coming to town to see me today (25 yrs., but still my baby)   Between that and reducing my riba.  Maybe I will be feeling better.  Also, I SHOULD get my viral load results today.  The NP did it Friday when I was there.   PRAY FOR UND>>>>>

Now all I need are my new docs on board....I will feel more secure when I get established with a new doc.  But in the meantime, thank God for my GP....

And for all you guys!!!

Jean

[CoWriter]

I found you something about antiplatelet antibodies you can show your doctor.  This study showed that interferon didn't induce the production of antiplatelet antibodies.

But I do agree with GoofyDad, a hemoglobin of 8.6 is too low. A low hemoglobin for an extended period of time can cause left ventriculat hypertrophy (thickening of the heart muscle) which causes exercise intolerance.....and it's a permanent problem.  



Antiplatelet antibodies in patients with chronic viral hepatitis receiving interferon-alpha.

Christodoulou D, Christou L, Zervou E, Katsanos K, Kitsanou M, Tsianos EV.
1st Department of Internal Medicine, Hepato-Gastroenterology Unit, Medical School, University of Ioannina, Greece.

BACKGROUND/AIMS: The aim of this study was to investigate the possible role of interferon-alpha in the development of antiplatelet IgG antibodies in patients with chronic viral hepatitis B or C.

METHODOLOGY: Ninety-one consecutive patients with chronic viral hepatitis (51 with chronic hepatitis B and 40 with chronic hepatitis C) were investigated for the presence of antiplatelet IgG antibodies in their serum immediately prior to IFN-alpha therapy and after six months of therapy. The method used was the solid phase red cell adherence test (Immucor, Norcross, USA), which is a sensitive tracer of antiplatelet antibodies. Some of the results were confirmed using an indirect immunofluorescence test for the detection of antiplatelet antibodies

RESULTS: Overall, we found that antiplatelet antibodies were present in 37.54% (19/51) of patients with chronic hepatitis B before IFN-alpha therapy and in 35.29% (18/51) after therapy. Moreover, antiplatelet antibodies were found in 20% (8/40) of patients with chronic hepatitis C before and after IFN-alpha therapy.

CONCLUSIONS: Therapy with IFN-alpha DID NOT INDUCE ANTIPLATELET ANTIBODIES in patients with chronic viral hepatitis B or C. Thrombocytopenia observed during IFN-alpha therapy in our study was NOT due to the development of antiplatelet antibodies.

PMID: 18019713

[alagirl]

Even if you were dehydrated, going up to 9.7 puts you a lot closer to the beanpole even if you were actually down at say, 9.  It shows that your body IS making an effort to rebound its hgb on its own, which is good.  You'll need to keep your bloodwork checked often and fortunately, your hematologist will likely follow this pretty closely since you're on a hemolytic agent that has already caused issues.  You won't likely get transfused until and unless you go under 8 - and you don't want a lot of transfusions you don't have to have.

I was hoping Jim would talk to you about the ANC, because he has a lot more experience and info on that topic.  I had some issues with it, but they weren't huge and did not occupy my time like my hgb did.  I'm glad you are on your way (hopefully) to being seen by a hepa with whom you will feel more comfortable.  

Somebody who knows what they are doing really DOES have to supervise your tx, when all is said and done.  Particularly with your issues you can't just be out in the wind - even without the complex issues you have.  I have just been hoping for you that getting a hematologist on board would persuade your current tx'ing doc to follow you at least until you get a new tx doc.

[GoofyDad]

IMHO, ongoing HGB of 8.6 is too low. OK for the short haul maybe, but not for the long. I know because I did it. Get thee to the procrit factory. A small reduction in riba will boost you up some too.  

Please drink your water.

[jt57]

Thanks for the advice on posting, Jim.  I'll get better at this as we go along, I'm sure!

Got myself set up with a hema dr.  (They could not see me today)  and my records are being sent to another hep Dr.   He is not seeing new patients right now, but may make an exception!!!!  Got a call from my Dr. office, NP, of course.  With my cbc results from Fri., which are bogus, because I was dehydrated!  Was in ER Sat. because of it.  He said my hgb from Fri. was 9.7.  Well, it was 8.6 on Thurs.,  Quite a jump, don't you think?  When I told him what I thought , and why, he just  said, "well, I am very pleased with these numbers!!"  

My GP called this morning.  follow up from the weekend.  wanted me to come by.  She ran my numbers again.  hgb 8.5, plt 62, wbc 2.0, anc 900.     All without any riba reduction like my dr. told me to do.  Not that these numbers are GREAT, but they certainly aren't critical.

[jmjm530]

Just wanted to add that I think you'll get better quality responses if you don't open up a new thread every time something new happens. Things will be easier for everyone to follow if you just post to the end of your own thread as long as things are more or less related as they have been the past few days. If also makes the forum a bit less cluttered.

-- Jim

[jmjm530]

My liver specialist would not be concerned with 4.0 ANC. In fact, mine was close to .3 and they didn't blink. No Neupogen. No dose reduction. Two weeks later it was up over 1, all by itself. That said, you really need to get to a new liver specialist ASAP to address all these concerns as you will need proper supervision and monitoring for these very powerful drugs. As to the dehydration thing -- very common on tx and nothing like IV fluids to make you feel a little better.

-- Jim

[merryBe]

listen to Alagirl, she's the queen of blood woes in here!

[alagirl]

You could always go back to the ER now, hydrated, and get that transfusion...  It takes eight days to make a new blood cell, so even though/when procrit is started you are going to be behind the eight ball for a little while and if you are taking riba the entire time then you could be dangerously depleted by then.  New blood, whether by procrit or transfusion, will likely help your wbc and platelets also.

[alagirl]

I was JUST going to say that when you are dehydrated your hgb is higher so those may not be true numbers.  You beat me to it! ;)

[jt57]

I found out that my levels from the ER were not TRUE NUMBERS!!!!  My blood was taken BEFORE they gave me fluids, therefore we were measuring concentrated cells.  Once I was hydrated, everything changed!!!  I found that out today when my GP had me to recheck my numbers.  anc is ok, 800, wbc is 1.8, hgb is now 7.9, platelets are 50.

and I thought I was doing so good.......

Jean

[merryBe]

yeah, I don't remember if it was you or someone else I spoke to this week about the hydration...two people I wrote...anyway, yes, not only can the lack of hydration increase your Riba lavels to dangerous, blood cell frying levels, but your marrow can also get dry. What comes out normally is pretty thick and syrupy, but without enough fluids it slows the marrows ability to express new cells into the blood stream.
In any case, I'm glad the thing was so fixable for you, I've also noticed my symptoms and sides are all worse without enough water, although it took a while to see the correlation. It's also important because kidneys get irritated from the riba and can shut down,  AND because skin tissue gets thin and dry and really needs the moisture. Somehow the tx just causes a lot of moisture problems. My eyes especially.
The rule of thumb is one litre per 100 lbs of weight.
You can buy water with electrolytes in it to make sure you don't get low on minerals, that also may help.
One way I've always gauged my water level is by my joint mobility. A lot of my patients swore to this being their indicator as well.  If you are felling stiffer, you probably disn't get enough fluid for the prior few days, as the cartilage dries out and the joints send nastigrams then.  Of course, even enough fluid won't help if you consume caffiene of other duiretic substances that robe the blood of minerals and flush fluid from the system.
Cola products are very bad and cause dehydration and loss of calcium as they contain
both caffience, and phosphoric acid, as very caustic unnatural substance. You should avoid these entirely, as especially during treatment.

mb

[CoWriter]

"Polychromasia" refers to variation in red cell coloration. This variation largely relates to the maturation of the cell. The younger cells will appear blue.  The mature form will stain orange-pink.

What this means is that your bone marrow is creating new red cells.  That's why your hemoglobin is now higher.

[jt57]

thank you so much Bill!  just as everyone else, I do not want to reduce, if at all possible.  I take #12 on monday.  But I am hoping have a hema on board will help me with my hep dr.  I thought we was an aggressive dr., but I am not so sure anymore.

I will go to that website and study what this means about my red blood cell abnormalities.  

Thanks again!!!

Jean

[Bill1954]

Hi Jean,

Sorry to hear your having trouble with treatment. Hang tight until you confer with the hematologist on Monday; from what you describe, you’ll be fine until then.  Teardrop cells and polychromasia are both red cell abnormalities that are consistent with significant hemolysis; I experienced both during my treatments. If you haven’t reviewed this yet, this site can be informative:

http://labtestsonline.org/understanding/analytes/blood_smear/details.html

An ANC result of .40 is definitely a yellow flag, and will probably need to be addressed; either by intervention with Neupogen (GCSF product), or via IFN dose reduction. Many aggressive physicians seem to allow ANC counts to .30 or so; however, it’s probably prudent to stay away from environmental sources of infection, such as young children, hospitals, airports, etc. If you work in a health-care environment, you might want to avoid work until this has been resolved.

Platelets seem to be resolving a bit; but still low. There is still no effective way short of transfusion to increase platelet counts; the current medication Neumega that is used for cancer chemo tends to have bad side effects and also further promotes hemolytic anemia, I believe. A new drug, Eltrombopag, is near FDA approval and may help future HCV patients with thrombocytopenia. Again, aggressive docs will allow some patients to drop to 20-25 k with platelets.

If you’re not currently taking Neupogen to encourage white counts, definitely discuss this with the hematologist Monday.

Best to you—

Bill