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Monitoring our Blood Work while on HCV Therapies
Found on this page: Found on Page Two:
Each cell, or leukocyte, has a different job in the body which is explained in the Differential section. DifferentialNEUTROPHILS and NEUTROPHIL COUNT LYMPHOCYTES and LYMPHOCYTE COUNT MONOCYTES and MONOCYTE COUNT EOSINOPHILS and EOSINOPHIL COUNT BASOPHILS and BASOPHIL COUNTNEUTROPHILS and NEUTROPHIL COUNTAlso 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 %
LYMPHOCYTES and LYMPHOCYTE COUNTLymphocytes 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 %
MONOCYTES and MONOCYTE COUNTThese 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 %
EOSINOPHILS and EOSINOPHIL COUNTEosinophils 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 %
BASOPHILS and BASOPHIL COUNTBasophilic 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 %
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? 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 and Ribavirin Alejandro Soza, James E. Everhart, Marc G. Ghany, Edward Doo, Theo Heller, Kittichai Promrat, Yoon Park, T. Jake Liang, and Jay H. Hoofnagle
Interferon therapy of hepatitis C causes a decrease in neutrophil counts, and neutropenia is a common reason for dose adjustment or early discontinuation. However, it is unclear whether neutropenia caused by interferon is associated with an increased rate of infection. In this study, we assessed factors associated and clinical consequences of neutropenia before and during interferon therapy of chronic hepatitis C. A total of 119 patients with chronic hepatitis C treated with the combination of interferon alfa and ribavirin were analyzed. In these studies, neutropenia was not used as an exclusion or dose modification criterion. In multivariate analysis, only black race was associated with baseline neutropenia. During treatment, neutrophil counts decreased by an average of 34%. Among 3 blacks with baseline neutropenia without cirrhosis or splenomegaly, there was little or no decrease in neutrophil counts (despite typical decreases in platelet and lymphocyte counts). Documented or suspected bacterial infections developed in 22 patients (18%), but in no patient with neutropenia. United States population estimates suggest that 76,000 blacks with hepatitis C have neutrophil counts below 1,500 cells/ L and might be denied therapy if this exclusion criterion was generally applied. In conclusion, neutropenia is frequent during treatment of hepatitis C with interferon and ribavirin, but it is not usually associated with infection. Constitutional neutropenia, which is common among blacks, should not exclude patients from therapy with interferon as these patients usually have minimal further decreases in neutrophil counts on therapy and are not excessively prone to bacterial infections. HEPATOLOGY 2002;36:1273-1279.) Neutrophil counts can fall to levels that are associated with an increase in risk of bacterial infections and sepsis. Indeed, in the recent large randomized con- trolled trials of pegylated or standard interferon combined with ribavirin neutropenia was listed as the most common reason for dose reduction (18% of patients) and was a reason for early drug discontinuation in 1% of patients. Furthermore, most studies have excluded patients with preexisting neutropenia ( 1,500 cells/ L). This exclusion criterion has major implications for select population groups with hepatitis C. Neutropenia is more common among black patients than whites and a larger proportion of blacks are excluded from trials of therapy of hepatitis C for this reason. Whereas the consequences of neutropenia are believed to be substantial, there is little evidence for adverse clinical implications of neutropenia induced by interferon particularly in patients with preexisting low white cell counts. At the Clinical Center of the National Institute of Health, clinical studies of therapy of hepatitis C have not used neutropenia as an exclusion criterion. We retrospectively have analyzed neutrophil counts during therapy of hepatitis C and occurrence of bacterial infec- tions. The effect of using neutropenia to exclude potential patients from treatment was determined among white and black participants in the Third National Health and Nutrition Examination Survey (NHANES 3). Below is an excerpt from the study found at the url listed below: In this analysis of neutrophil counts among 119 pa- tients treated at a single referral center, neutropenia was not used as an exclusion criterion and therapy was safely accomplished despite decreases in neutrophils below the usual levels that lead to dose reduction or drug interrup- tion. Bacterial infections did not occur in neutropenic patients, and the only severe infection that was identified occurred in an elderly patient with preexisting cirrhosis. Of potential interest, the only baseline measure that pre- dicted subsequent infection was low reticulocyte count. We are unaware of other information linking reticulocyte count to subsequent infections. Nevertheless, the associ- ation was strong and deserves further investigation. There was poor correlation between total white blood cell count and neutrophil count in patients with neutro- penia, indicating that measurement of absolute neutro- phil count instead of total white blood cell count is necessary in monitoring therapy. Of greatest importance, 3 patients were treated who appeared to have constitu- tional neutropenia, marked by persistently low neutrophil counts (below 1,500 cells/ Click below to read the study in its entirety;
PDF]Neutropenia
During Combination Therapy of Interferon Alfa and ...
Laboratory Tests: The following laboratory tests are recommended prior to initiating interferon beta-1b therapy and at periodic intervals thereafter: 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. The study protocol stipulated that interferon beta-1b therapy be discontinued in the event the absolute neutrophil count fell below 750/mm When the absolute neutrophil count had returned to a value greater than 750/mm therapy could be restarted at a 50% reduced dose. No patients were withdrawn or dose-reduced for neutropenia or lymphopenia. Similarly, if AST/ALT levels exceeded 10 times the upper limit of normal, or if the serum bilirubin exceeded 5 times the upper limit of normal, therapy was discontinued. In each instance during the controlled MS trial, hepatic enzyme abnormalities returned to normal following discontinuation of therapy. When measurements had decreased to below these levels, therapy could be restarted at a 50% dose reduction, if clinically appropriate. Dose was reduced in two patients due to increased liver enzymes; one continued on treatment and one was ultimately withdrawn.
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.
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Reviewed May 1 2004 |