Thyroid function test, hemoglobin, complete and differential white blood cell counts, platelet counts and blood chemistries including liver function tests. A pregnancy test, chest roentgenogram and ECG should also be performed prior to initiating interferon beta-1b therapy. Also an eye exam should be preformed.

On September 23, 2008, the FDA released a statement known as an “Early Communication,” indicating that they were reviewing the data from this study to evaluate the potential connection between Procit and Epogen and increased mortality.

Index of Information Listed Below:

Understanding your blood counts / Rescue drugs: Procrit/Epogen/Neupogen/ Neumega/ What are white blood cells? / What happens when your white cells are to low on HCV therapy?/ White blood counts: What is to low ?/ What are Red Blood Cells ?/ What happens when Ribavirin or (COPEGUS) lowers your red blood count?/ Red Blood Cells : What is to low?

Understanding your blood counts

Complete blood count

A complete blood count (CBC)—sometimes referred to as your “numbers”—helps you and your doctor monitor the effects of your therapy by measuring cells in your blood in relation to normal ranges. “Normal” ranges provide a reference, but your doctor and nurse will evaluate your specific counts and work with you to determine if there are any problems to address.

A complete blood count measures amounts of 3 types of cells in your blood

		White Blood Cells (WBCs) WBCs help your body fight infection by protecting against foreign invaders such as bacteria and viruses. WBCs form a key part of your natural defenses, which are provided by your immune system. Neutrophils (NEW-truh-fils), a specific type of WBC, help protect against and fight infection. If your absolute neutrophil count (ANC) falls below normal, you have neutropenia. ANC is the typical measure of your body's ability to fight infection.

		Red Blood Cells (RBCs) RBCs carry oxygen throughout your body, giving you energy and keeping your organs and tissues healthy. Hemoglobin (HEE-moh-glow-bin), also known as Hb, is the protein that makes blood red. It contains iron and carries oxygen in your body. Hematocrit (hee-MAT-oh-crit), or Hct, is the percentage of red blood cells in the bloodstream. If your Hb or Hct level is too low, you may have anemia (ah-NEE-mee-ah), in which case you may feel tired and fatigued.

		Platelets (Plts) Platelets help your body stop bleeding by working with other blood factors to form a clot. A low platelet count, called thrombocytopenia (throm-boh-sy-toh-PEE-nee-ah), may lead to excessive bleeding or bruising.

Hepatitis C Therapy can reduce the number of blood cells in your body


Track your blood counts against normal ranges


	Normal Ranges - Male	Normal Ranges - Female



White Blood Cells (WBC) Neutrophils (ANC) Red Blood Cells (RBC) Hemoglobin (Hb) Hematocrit (Hct) Platelets (Plt)	5,000-10,000/mm³ 2,000/mm³ and above 4.5-5.3 14-18 g/dL 42%-52% 150,000-400,000/mm³	5,000-10,000/mm³ 2,000/mm³ and above 4.1-5.1 12-16 g/dL 37%-47% 150,000-400,000/mm³

	mm = millimeters g/dL = grams per deciliter

Rescue drugs: Procrit/Epogen

Hepatitis C Treatment and Anemia

Might be prescribed if hemoglobin is <10 depending on your physician and over all health

Generic Name: epoetin alfa (e POE e tin AL fa)
Brand Names: Epogen, Procrit

Please see Full Prescribing Information, including Boxed WARNINGS for more details.

Medication Guide for PROCRIT
Please read the Medication Guide for PROCRIT and discuss with your doctor.

Patient Instructions for Use
Instructions if you or your caregiver has been trained to give PROCRIT injections at home.

Procrit is a man-made form of a protein that helps your body produce red blood cells. The amount of this protein in your body may be reduced when you have kidney failure or use certain medications. When fewer red blood cells are produced, you can develop a condition called anemia.

Procrit is used to treat anemia (a lack of red blood cells in the body).

Procrit may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Procrit?

This medicine can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use Procrit. Seek emergency medical help if you have symptoms of heart or circulation problems, such as chest pain or heavy feeling, pain spreading to the arm or shoulder, shortness of breath, slurred speech, or problems with vision or balance.

Before using Procrit, tell your doctor if you have epilepsy or a history of seizures. Procrit may cause seizures. Be careful if you drive or do anything that requires you to be awake and alert.

Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of all items used in giving the medicine. Contact your doctor if you feel weak, light-headed, or short of breath, or if your skin looks pale. These may be signs that your body has stopped responding to Procrit. Some women using Procrit have started having menstrual periods, even after not having a period for a long time due to a medical condition. You may be able to get pregnant if your periods restart. Talk with your doctor about the need for birth control.

Procrit is made from human plasma (part of the blood) and may contain viruses and other infectious agents that can cause disease. Although donated human plasma is screened, tested, and treated to reduce the risk of it containing anything that could cause disease, there is still a small possibility it could transmit disease. Talk with your doctor about the risks and benefits of using this medication.

What should I discuss with my healthcare provider before using Procrit?

Do not use this medication if you are allergic to epoetin alfa, darbepoetin alfa (Aranesp), or if you have:

untreated or uncontrolled high blood pressure;
an allergy to animal products; or
an allergy to albumin.

Before using Procrit, tell your doctor if you have:

heart disease, congestive heart failure, or high blood pressure (hypertension);
kidney disease (or if you are on dialysis);
a history of stroke, heart attack, or blood clots;
a blood cell or clotting disorder, such as sickle cell anemia or hemophilia;
cancer; or
epilepsy or another seizure disorder.

If you have any of the conditions listed above, you may need a dose adjustment or special tests to safely use Procrit.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether Procrit passes into breast milk or if it could harm a nursing baby. Do not use Procrit without telling your doctor if you are breast-feeding a baby. Some women using Procrit have started having menstrual periods, even after not having a period for a long time due to a medical condition. You may be able to get pregnant if your periods restart. Talk with your doctor about the need to use birth control while you are using Procrit.

Procrit may shorten remission time in some people with head and neck cancer who are also being treated with radiation. Procrit may also shorten survival time in certain people with breast cancer, non-small cell lung cancer, head and neck cancer, cervical cancer, or lymphoid cancer. Talk with your doctor about your individual risk.

How should I use Procrit?

Use this medication exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from Procrit.

Procrit is given as an injection under the skin or into a vein. Your doctor, nurse, or pharmacist will give you specific instructions on how and where to inject this medicine. With your medication you will receive patient instructions.

Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of needles, IV tubing, and other items used in giving the medicine.

Do not shake the medication vial (bottle). Vigorous shaking can ruin the medicine. Do not draw your Procrit dose into a syringe until you are ready to give yourself an injection. Do not use the medication if it has changed colors or has any particles in it. Call your doctor for a new prescription.

Use each disposable needle only one time. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

Store Procrit in the refrigerator and do not allow it to freeze.

To be sure this medication is helping your body produce red blood cells, your blood will need to be tested on a regular basis. You may also need to check your blood pressure during treatment. Do not miss any scheduled appointments.

What happens if I miss a dose?

Contact your doctor if you miss a dose of Procrit.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include headache, dizziness, itching (especially after bathing), fullness in your upper stomach, redness of the face, shortness of breath, and vision problems.

What should I avoid while using Procrit?

Procrit can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Procrit side effects

Contact your doctor if you feel weak, lightheaded, or short of breath, or if your skin looks pale. These may be signs that your body has stopped responding to Procrit.

Procrit can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use Procrit. Seek emergency medical help if you have symptoms of heart or circulation problems, such as:

chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
feeling short of breath, even with mild exertion;
sudden numbness or weakness, especially on one side of the body;
sudden headache, confusion, problems with vision, speech, or balance; or
pain or swelling in one or both legs.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using Procrit and call your doctor at once if you have any of these serious side effects:

feeling short of breath, even with mild exertion;
swelling of your ankles or feet;
increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness);
feeling light-headed, fainting; or
seizure (black-out or convulsions).

Less serious side effects may include:

dizziness, mild headache;
fever, sore throat, body aches, flu symptoms;
nausea, vomiting, diarrhea, constipation; or
pain or tenderness where you injected the medication.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect Procrit?

There may be other drugs that can affect Procrit. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about Procrit.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Procrit only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

http://www.drugs.com/procrit.html

Neumega

Prevention of severe reductions in the number of blood clotting cells (platelets) caused by some chemotherapy. It may also be used for other conditions as determined by your doctor.

Neumega is an interleukin. It works by stimulating certain body chemicals to produce platelets that function normally and have a normal life span.

Do NOT use Neumega if:

you are allergic to any ingredient in Neumega

Contact your doctor or health care provider right away if any of these apply to you.

Before using Neumega :

Some medical conditions may interact with Neumega . Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have a history of leukemia, multiple myeloma (disease of the bone marrow), bone marrow transplant, brain tumors, or other tumors involving the central nervous system
if you consume 3 or more alcohol-containing beverages a day
if you have a history of irregular heart rhythm, high blood pressure, stroke, congestive heart failure, other heart disease, or lung problems
if you have kidney problems, are taking diuretics ("water pills") to decrease the amount of fluid in your body, have a history of fluid retention, or have low potassium levels in your blood
if you have a history of swelling of the eye or have an eye disease (eg, papilledema)

Some MEDICINES MAY INTERACT with Neumega . However, no specific interactions with Neumega are known at this time.

This may not be a complete list of all interactions that may occur. Ask your health care provider if Neumega may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine

How to use Neumega :

Use Neumega as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Neumega comes with an additional patient leaflet. Read it carefully and reread it each time you get Neumega refilled.
Neumega is usually administered as an injection at your doctor's office, hospital, or clinic. If you are using Neumega at home, carefully follow the injection procedures taught to you by your health care provider.
If Neumega contains particles or is discolored, or if the vial is cracked or damaged in any way, do not use it.
Neumega should be injected in the stomach, hip, or thigh. It may be injected into the upper arm if it is given by another qualified individual. Neumega must be injected under the skin not in the muscle.
When drawing a dose into a syringe, be sure to follow the procedure demonstrated to you to prevent contamination of the vial, syringe, or medicine. Never touch the rubber stopper of the vial or needle of the syringe with your fingers.
Carefully check that you have drawn the correct dose before administration.
Do not shake Neumega .
Neumega works best if it is taken at the same time each day.
Continue using Neumega for the full course of treatment even if you feel better in a few days.
You should stop using Neumega at least 2 days before starting the next planned cycle of cancer chemotherapy.
Keep this product, as well as syringes and needles, out of the reach of children. Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor, nurse, or pharmacist to explain local regulations for proper disposal.
If you miss a dose of Neumega , use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once. If more than one dose is missed, contact your doctor or pharmacist.

Ask your health care provider any questions you may have about how to use Neumega .

Important safety information:

Neumega may cause dizziness or fainting. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Neumega . Using Neumega alone, with certain other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks.
Serious eye problems (papilledema) may occur more often in children.
Contact your health care provider if shortness of breath or irregular heartbeat occurs or worsens while using Neumega .
LAB TESTS, including complete blood cell count, platelet count, and electrolyte levels, may be performed to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.
Use Neumega with extreme caution in CHILDREN younger than 12 years of age. Safety and effectiveness in this age group have not been confirmed.
PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using Neumega during pregnancy. It is unknown if Neumega is excreted in breast milk. Do not breast-feed while taking Neumega .

Possible side effects of Neumega :

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Chills; constipation; cough; diarrhea; dizziness; fever; flushing; hair loss; headache; increased cough; indigestion; inflammation or sores of the mouth or lips; joint pain; loss of appetite; mild swelling of the arms and legs; muscle pain; nausea; nervousness; pain; runny nose; shortness of breath when moving; sleeplessness; sore throat; stomach pain; vomiting; weakness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); eye infection; eye pain; fainting; heart flutter; irregular or fast heartbeat; pain, redness, or swelling at the injection site; pounding in the chest; severe headache, dizziness, or one-sided weakness; unusual bruising; unusual or severe swelling; vision changes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org), or emergency room immediately. Symptoms may include continuing irregular or fast heartbeat.

Proper storage of Neumega :

Store powder and the dilution solution in the refrigerator, between 36 and 46 degrees F (2 and 8 degrees C). Protect from light. Do not freeze. Mixed solution must be used within 3 hours and be stored in the vial at 36 to 46 degrees F (2 and 8 degrees C) or at room temperature, up to 77 degrees F (25 degrees C). Do not freeze or shake Neumega after it is mixed. Do not store in the bathroom. Keep Neumega out of the reach of children and away from pets.

General information:

If you have any questions about Neumega , please talk with your doctor, pharmacist, or other health care provider.
Neumega is to be used only by the patient for whom it is prescribed. Do not share it with other people.
If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Neumega . If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: March 4, 2009

Database Edition 09.1.1.003

Neupogen

Download PDF Version of NEUPOGEN^® Prescribing Information

Neupogen is a man-made form of a protein that stimulates the growth of white blood cells in your body. White blood cells help your body fight against infection.

Neupogen is used to treat neutropenia, a lack of certain white blood cells caused by cancer, bone marrow transplant, receiving chemotherapy, or by other conditions.

Neupogen may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Neupogen?

Before using Neupogen, tell your doctor if you have sickle cell disorder, a blood cell disorder, chronic myeloid leukemia, myelodysplasia (also called "preleukemia"), or if you are receiving chemotherapy or radiation treatment.

Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of needles, IV tubing, and other items used in giving the medicine.

Neupogen is usually given daily for up to 2 weeks. Follow your doctor's instructions. For best results, use this medication at the same time each day.

To be sure this medication is helping your condition, your blood will need to be tested often. This will help your doctor determine how long to treat you with Neupogen. Your liver function will also need to be tested. Do not miss any scheduled appointments.

What should I discuss with my healthcare provider before using Neupogen?

Do not this medication if you are allergic to filgrastim or to other medicines that contain the E. coli bacteria.

Before using Neupogen, tell your doctor if you are allergic to any drugs, or if you have:

sickle cell disorder;
a blood cell disorder;
chronic myeloid leukemia;
myelodysplasia (also called "preleukemia"); or
if you are receiving chemotherapy or radiation treatment.

If you have any of these conditions, you may need a dose adjustment or special tests to safely use Neupogen.

How should I use Neupogen?

Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Neupogen is given as an injection through a needle placed into a vein. Your doctor, nurse, or other healthcare provider will give you this injection. You may be shown how to use your medicine at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of needles, IV tubing, and other items used in giving the medicine.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Neupogen should not be given within the 24-hour period before or after you receive chemotherapy.

Neupogen is usually given daily for up to 2 weeks. Follow your doctor's instructions. For best results, use this medication at the same time each day.

Do not shake the medication vial (bottle) or prefilled syringe. Vigorous shaking can ruin the medicine. Do not draw your Neupogen dose into a syringe until you are ready to give yourself an injection. Do not use the medication if it has changed colors or has any particles in it. Call your doctor for a new prescription.

Use a different place on your arms, stomach, hips, or legs each time you give yourself an injection. Your care provider will show you the places on your body where you can safely inject the medication. Do not inject into the same place two times in a row.

A Neupogen vial or prefilled syringe is for one use only. Throw the bottle or syringe away after using, even if there is still some medicine left inside. Do not use Neupogen if the expiration date on the label has passed. Call your doctor for a new prescription.

Store this medication in the refrigerator and do not allow it to freeze. You may allow the medication to reach room temperature for 24 hours before measuring your dose in a syringe. Then place the vial back in the refrigerator. Throw away any Neupogen that has been left out at room temperature for longer than 24 hours.

What happens if I miss a dose?

Use the missed dose as soon as you remember, but not within the 24-hour period before or after you receive chemotherapy treatment. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a Neupogen overdose are not known.

What should I avoid while using Neupogen?

Follow your doctor's instructions about any restrictions on food, beverages, or activity while you are using Neupogen.

Avoid being near people who have colds, the flu, or other contagious illnesses. Contact your doctor at once if you develop signs of infection.

Neupogen side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using Neupogen and call your doctor at once if you have any of these serious side effects:

sudden or severe pain in your left upper stomach spreading up to your shoulder;
rapid breathing or feeling short of breath;
fever, chills, body aches, flu symptoms;
easy bruising or bleeding, unusual weakness;
white patches or sores inside your mouth or on your lips;

Less serious side effects may include:

nausea, vomiting, loss of appetite;
diarrhea, constipation;
bone pain;
muscle aches;
hair loss;
headache, tired feeling;
mild skin rash; or
itching, swelling, or redness where the medicine was injected.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect Neupogen?

Before using Neupogen, tell your doctor if you are also using lithium (Eskalith, Lithobid, Lithane, and others). You may need a dose adjustment or special tests to safely use Neupogen.

There may be other drugs that can interact with Neupogen. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about Neupogen.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

What are white blood cells?

White blood cells, also called leukocytes, are cells that your body makes to help fight infections. There are several kinds of white blood cells. The two most common types are lymphocytes and neutrophils. Neutrophils are also sometimes called granulocytes or polymorphonuclear leukocytes (PMNs or "polys").

A white blood cell count (WBC) is performed by counting the number of white
blood cells in a sample of your blood. A normal WBC is in the range of 4,000 to
11,000 cells per microliter (mm3).

W.B.C. (White Blood Cell Count)

Normal Adult Range: 3.8 - 10.8 thous/mcl
Optimal Adult Reading: 7.3
Higher ranges are found in children, newborns and infants.

What are lymphocytes?

Lymphocytes come from your lymph tissue (spleen, lymph nodes, thymus gland).
There are different kinds of lymphocytes, including CD4 cells (T-helper cells) and
CD8 cells (T-suppressor cells). Lymphocytes identify foreign substances from
bacteria or viruses in your body and produce antibodies and cells that specifically
target them. It takes from several days to weeks for lymphocytes to recognize and
attack a new foreign substance.

What are neutrophils?

Neutrophils are a major part of your body’s defense against bacterial infections.
When the WBC is low, there may not be enough neutrophils to defend you against
bacterial infections.

Neutrophils are made in the bone marrow and circulate in the bloodstream.
Neutrophils move out of the blood vessels into the infected tissue to attack the
bacteria. The pus in a boil (abscess) is made up mostly of neutrophils. Normally a
serious bacterial infection causes the body to produce an increased number of
neutrophils, resulting in a higher than normal WBC.

A normal absolute neutrophil count (ANC) is in the range of 1,500/mm3 to
8,000/mm3. If the ANC is below 500/mm3 for an extended period of time, your risk of serious bacterial infection may increase significantly. A low neutrophil count is also called neutropenia.

White blood cells main function is to fight infection, defend the body by phagocytosis against invasion by foreign organisms, and to produce, or at least transport and distribute, antibodies in the immune response.

Granulocytes	Nongranulocytes
Band Neutrophiles	Lymphocytes
Neutrophils	Monocytes
Eosinophils
Basophils

Each cell, or leukocyte, has a different job in the body which is explained in the Differential section.

Differential

NEUTROPHILS and NEUTROPHIL COUNT

LYMPHOCYTES and LYMPHOCYTE COUNT

MONOCYTES and MONOCYTE COUNT

EOSINOPHILS and EOSINOPHIL COUNT

BASOPHILS and BASOPHIL COUNT

NEUTROPHILS and NEUTROPHIL COUNT

Also known as Granulocytes or segmented neutrophils, this is the main defender of the body against infection and antigens. High levels may indicate an active infection, a low count may indicate a compromised immune system or depressed bone marrow (low neutrophil production.

Normal Adult Range: 48 - 73 %
Optimal Adult Reading: 60.5
Normal Children’s Range: 30 - 60 %
Optimal Children’s Reading: 45

LYMPHOCYTES and LYMPHOCYTE COUNT

Lymphocytes are involved in protection of the body from viral infections such as measles, rubella, chickenpox, or infectious mononucleosis. Elevated levels may indicate an active viral infection and a depressed level may indicate an exhausted immune system or if the neutrophils are elevated an active infection.

Normal Adult Range: 18 - 48 %
Optimal Adult Reading: 33
Normal Children’s Range: 25 - 50 %
Optimal Children’s Reading: 37.5

MONOCYTES and MONOCYTE COUNT

These cells are helpful in fighting severe infections and are considered the bodies second line of defense against infection and are the largest cells in the blood stream. Elevated levels are seen in tissue breakdown or chronic infections, carcinomas, leukemia (monocytic) or lymphomas. Low levels are indicative of a state of health.

Normal Adult Range: 0 - 9 %
Optimal Adult Reading: 4.5

EOSINOPHILS and EOSINOPHIL COUNT

Eosinophils are used by the body to protect against allergic reactions and parasites. Therefore, elevated levels may indicate an allergic response. A low count is normal.

Normal Adult Range: 0 - 5 %
Optimal Adult Reading: 2.5

BASOPHILS and BASOPHIL COUNT

Basophilic activity is not fully understood but it is known to carry histamine, heparin and serotonin. High levels are found in allergic reactions, low levels are normal.

Normal Adult Range: 0 - 2 %
Optimal Adult Reading: 1

What happens when your white cells are to low on treatment?

People taking the 1.0 and 1.5mcg/kg dose of peg-interferon experienced slightly more side effects than those on the other two doses. The most common side effects included headaches, fatigue, flu-like symptoms, depression, and decreases in white blood cell counts, platelets (cells needed for blood-clotting) and neutrophils (a type of white blood cell that helps control bacterial and other infections).

What causes a low neutrophil count?

Neutrophils die continuously from age or from fighting infections, and your bone
marrow must make new neutrophils to replace them. When something reduces
production of neutrophils in your bone marrow, the neutrophil count will drop and
may become dangerously low.

Prescription medications, such as trimethoprim-sulfamethoxazole (TMP-SMX,
Bactrim, Septra), ganciclovir, zidovudine (AZT), interferon, pyrimethamine,
primaquine, and many chemotherapy agents used for Kaposis' sarcoma and
lymphoma are common causes of neutropenia. In almost all cases, drug-induced
neutropenia (low white count) resolves after the agent is stopped or its dosage is reduced.

Drugs that Help Low White Count

Neupogen (G-CSF): a colony stimulating factor (CSF)that signals the bone marrow to increase output of white cells (specifically neutrophils), which help to fight bacterial infections.

Neulasta: a protein that stimulates the production on white blood cells.

Neutropenia during combination therapy of interferon alfa and ribavirin for chronic hepatitis C

White blood counts: What is to low ?

Combination therapy with interferon and ribavirin commonly drives down the white count and especially a certain type of white cell called neutrophils that are important in fighting bacterial infections. It is important for people to appreciate that it is the interferon part of the treatment that really drives down the white count. It is possible that the Rebetol (ribavirin) part contributes but we know that when we use interferon alone, we see the same problem. As a result, if the white count or the neutrophil count gets to be very low, we typically adjust down the interferon dose and not the Rebetol dose.

There are a couple of additional comments. First, with time and experience, we have to come to appreciate that our hepatitis C patients can tolerate a lower white count on treatment than we originally felt comfortable with. If we are able to keep the neutrophil count (ANC) above 750, patients do not typically develop infections. Secondly, we can sometimes use a second drug called GM-CSF or Neupogen to keep up the white count. Neupogen is a drug that is used primarily for cancer patients receiving chemotherapy. It is effective in getting the bone marrow to make more white cells. Like interferon, it has to be injected.

http://www.medhelp.org/forums/hepatitis/archive/904.html

Neutrophil% x White Blood Cell = Absolute Neutrophil Count

For example, if a person's white blood cell count were 6,000 cells, and neutrophils made up 50% of those, that person's absolute neutrophil count would be 3,000.

A normal range for neutrophil% is between 33% and 72%. This makes the normal range for the ANC between 1500 and 7200. Since every individual is unique, you should consult your physician or nurse if you have questions concerning your white blood cell count and ANC.

If you’re total white count is 1.0 (1000) or below then your neutrophils would be around 500… to low to continue therapy. Although treatment is not always discontinued (in some cases) the dose is cut back until the white count increases.

What are Red Blood Cells ?

Red blood cells carry oxygen from the lungs to cells throughout the body. This is measured by three main tests. The Red Blood Cell Count (RBC) is the total number of red blood cells. Hemoglobin (HGB) is a protein in red blood cells that actually carries oxygen from the lungs to the rest of the body. Hematocrit (HCT) measures the percentage of blood volume taken up by red blood cells.

A high RBC is common for people who live at high altitude. It's a way the body adjusts to thinner oxygen.

Very low readings for RBC, hemoglobin and hematocrit can indicate anemia. With anemia, the cells do not get enough oxygen to function normally. People with anemia feel tired all the time and might look pale.

R.B.C. (Red Blood Cell Count)

Normal Adult Female Range: 3.9 - 5.2 mill/mcl
Optimal Adult Female Reading: 4.55
Normal Adult Male Range: 4.2 - 5.6 mill/mcl
Optimal Adult Male Reading: 4.9
Lower ranges are found in Children, newborns and infants

HEMOGLOBIN (HGB)

Hemoglobin is the main transport of oxygen and carbon dioxide in the blood. It is composed of globin a group of amino acids that form a protein and heme which contains iron atoms and the red pigment, porphyrin. As with Hematocrit, it is an important determinant of anemia (decreased), dehydration (increased), polycythemia (increased), poor diet/nutrition, or possibly a malabsorption problem.

Normal Adult Female Range: 12 - 16%
Optimal Adult Female Reading: 14
Normal Adult Male Range: 14 - 18%
Optimal Adult Male Reading: 16
Normal Newborn Range: 14 - 20%
Optimal Newborn Reading: 17

HEMATOCRIT (HCT)

The word hematocrit means "to separate blood," a procedure which is followed following the blood draw through the proper use of a centrifuge. Hematocrit is the measurement of the percentage of red blood cells in whole blood. It is an important determinant of anemia (decreased) , polycythemia (increased), dehydration (elevated), increased R.B.C. breakdown in the spleen (elevated), or possible overhydration (elevated)

Normal Adult Female Range: 37 - 47%
Optimal Adult Female Reading: 42%
Normal Adult Male Range 40 - 54%
Optimal Adult Male Reading: 47
Normal Newborn Range: 50 - 62%
Optimal Newborn Reading: 56

What are platelets?

Platelets are cell fragments from the bone marrow that circulate through the
bloodstream, helping your blood to clot. In places where there are breaks in vessels,
platelets form plugs with serum proteins (clotting factors) to prevent blood loss while
healing takes place.

What is a platelet count?

A platelet count is a blood test done by counting the number of platelets in a known
volume of blood. A normal platelet count is in the range of 150,000 to 450,000 per
microliter (mm3). A low platelet count is called thrombocytopenia. If your platelet
count drops below 50,000/mm3, you may not be able to stop bleeding after a serious
injury. If you have a platelet count below 20,000/mm3, bleeding may occur
spontaneously.

What are the symptoms and signs of a low platelet count?

Persons with a low platelet count may bruise easily or bleed from the mouth or
rectum. If any of these symptoms are present, your platelet count could be low, but
other explanations are also possible.

PLATELET COUNT

Platelets (also known as thrombocytes) are the smallest formed elements of the blood. They are vital to coagulation of the blood to prevent excessive bleeding. Elevated levels suggest dehydration or stimulation of the bone marrow where the cells are produced and decreased levels may indicate an immune system failure, drug reactions, B12 or folic acid deficiency.

Normal Adult Range: 130 - 400 thous/mcl
Optimal Adult Reading: 265
Higher ranges are found in children, newborns and infants.

Hematology

MCH (Mean Corpuscular Hemoglobin)

Hemoglobin x 10
R.B.C.

Mean Corpuscular Hemoglobin (MCH) gives the average weight of hemoglobin in the red blood cell. Due to its use of red blood cells in its calculation, MCH is not as accurate as MCHC in its diagnosis of severe anemia's. Decreased MCH is associated with microcytic anemia and increased MCH is associated with macrocytic anemia.

Normal Adult Range: 27 - 33 pg
Optimal Adult Reading: 30

MCV (Mean Corpuscular Volume)

Hematocrit x 10
R.B.C.

The Mean Corpuscular Volume reflects the size of red blood cells by expressing the volume occupied by a single red blood cell. Increased readings may indicate macrocytic anemia or B6 or Folic Acid deficiency and decreased readings may indicate microcytic anemia, possibly caused by iron deficiency.

Normal Adult Range: 80 - 100 fl
Optimal Adult Reading: 90
Higher ranges are found in newborns and infants

MCHC (Mean Corpuscular Hemoglobin Concentration)

Hemoglobin x 100
Hematocrit

This test measures the average concentration of hemoglobin in red blood cells. It is most valuable in evaluating therapy for anemia because Hemoglobin and Hematocrit are used, not R.B.C. in the calculation. Low MCHC means that a unit of packed R.B.C.’s contain less hemoglobin than normal and a high MCHC means that there is more hemoglobin in a unit of R.B.C.’s. Increased MCHC is seen in spherocytosis, and not seen in pernicious anemia whereas decreased levels may indicate iron deficiency, blood loss, B6 deficiency of thalassemia.

Normal Adult Range: 32 - 36 %
Optimal Adult Reading: 34
Higher ranges are found in newborns and infants

What happens when Ribavirin or (COPEGUS) lowers your red blood count?

Low platelets are referred to as thrombocytopenia. Low red blood cells or hemoglobin is called anemia.

Will Procrit help low platelets? No, it won't , there are other medications which can increase platelets. But if you're anemic, definitely talk to your doctor about Procrit.

Drugs to Help low platelets:

Neumega: a growth factor that stimulates the bone marrow to increase production of platelets.

In the mid-1990s, a new drug was added to the arsenal. This is ribavirin (Rebetron®). Ribavirin is an antiviral drug which has been used in children to treat a serious lung virus. It was approved by the FDA in 1998 for use in patients with Hepatitis C. Ribavirin does not work when used alone - it requires combination therapy with interferon to see a response. The most important use of ribavirin is it's apparent ability to keep patients who respond to the interferon in a sustained response (40-50%!). Not everyone can take ribavirin, however. The drug causes a fairly severe anemia (low red blood cells), which can complicate high blood pressure, diabetes, or heart disease.

Ribavirin accumulates in the red blood cells and damages them, shortening their life in the body. The body compensates by making more red blood cells, but many people cannot keep pace with the accelerated loss of red cells caused by ribavirin. Red blood cells carry oxygen from the lungs to the rest of the body, and if the red blood cell count drops too much, a person will feel easily tired. Most people have only a small reduction in red blood cells, but for some people the drop is severe. For some people, even a minor drop in red blood cells can be dangerous. For example, someone with heart disease might develop a heart attack if the red cell count were to drop, or someone who is already anemic from another cause could become severely anemic on ribavirin. Therefore it is important to monitor the red blood cell count while on ribavirin, and to be doubly careful with persons with heart disease or pre-exisiting anemia.
The anemia caused by ribavirin resolves when ribavirin is stopped, usually within one to two months.

COPEGUS tablets may cause birth defects and/or death of an unborn child. If you are pregnant, you or your male partner must not take PEGASYS in combination with COPEGUS. You must not become pregnant while either you or your partner is being treated with the combination of PEGASYS and COPEGUS or for 6 months after stopping therapy. Men and women should use birth control while taking the COPEGUS with PEGASYS and for 6 months afterwards. If you or your partner is being treated and you become pregnant either during treatment or within 6 months of stopping treatment, call your doctor right away.

http://www.gidoctors.com/Hepatitis/ribavirin.htm

Red Blood Cells : What is to low?

Adjust the dose of Ribavirin downward (by 200 mg at a time) if significant anemia occurs (hemoglobin less than 10 gm/dL or hematocrit < 30 percent)

Stop Ribavirin if severe anemia occurs (hemoglobin < 8.5 gm/dL or hematocrit < 26 percent).

Hemoglobin:

Normal Adult Female Range: 12 - 16%
Optimal Adult Female Reading: 14
Normal Adult Male Range: 14 - 18%
Optimal Adult Male Reading: 16
Normal Newborn Range: 14 - 20%
Optimal Newborn Reading: 17

Hematocrit:

Normal Adult Female Range: 37 - 47%
Optimal Adult Female Reading: 42%
Normal Adult Male Range 40 - 54%
Optimal Adult Male Reading: 47
Normal Newborn Range: 50 - 62%
Optimal Newborn Reading: 56

http://mobile.handheldmed.com/mobile/niddk/hepc/k.html

Ribavirin Induced Anemia
07/17/2001

Approximately 10% of patients receiving ribavirin develop significant anemia (1). This anemia results mostly from intravascular hemolysis (premature break up of red blood cells within the blood vessels). The anemia is dose dependent and is not worsened by the presence of interferon therapy. It also resolves within a few weeks after discontinuation of the medicine. On the average, the hemoglobin concentration drops by 2 to 3 g/dl for patients on standard dose ribavirin (1000 mg to 1200 mg a day).

As the hemoglobin falls, patients may experience worsened fatigue, dyspnea on exertion (shortness of breath with exertion), lightheadedness, palpitations and even chest pain especially if there is preexisting coronary artery disease and if the hemoglobin concentration falls below 10g/dl.

Managing Hemoglobin Levels

Because hemoglobin levels are routinely monitored during the course of therapy, it is quite easy to identify the emergence of the drug-induced anemia before significant symptoms occur. When the hemoglobin concentration falls below 10g/dl, ribavirin dosage should be decreased to around 600mg/day. This decrease in dose often results in a 1 g/dl to 1.5 g/dl increase in the hemoglobin. While dose reduction has been the standard of care in this setting, recent data suggest that the concomitant use of erythropoietin (a hormone that stimulates the bone marrow to make more red blood cells) may be beneficial in the management of ribavirin induced anemia (2).

In summary, ribavirin induced decrease in hemoglobin levels is common; significant anemia may result and require dose reduction. It is rare for the drug to be stopped as a result of anemia. There is data that erythropoietin may help in the management of the anemia, but erythropoietin is expensive and the data preliminary. This author would like to see more data on this issue before advocating its routine use for patients.

References:

1. McHutchinson JG, Gordon SC, Schiff ER et al. (1998). Interferon alpha-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. NEJM; 339:1485-1492

2. Wasserman R, Braun N, Hassanein TI et al. Once weekly epoetin alpha increases hemoglobin and decreases ribavarin discontinuation among HCV patients who develop anemia on RBV/INF therapy. Hepatology. 2000; 32: abstract 833.

Found on Page Two :

Results of Blood work done while on Rebetron (Interferon with Ribavarin)

Protocol When to Administer Blood Test While on PegInron\Ribavirin

Reviewed May 1 2004