t know if it would drop that quickly. I do my interferon shot on Friday eve and cbc and neupogen shot on Monday. Mondays ANC levels are always much lower than Thursday's cbc.
If possible, maybe you could do the cbc the day prior to the interferon shot to see the difference.
Smart move on reducing to a 40 hr week since rest may become more important as you get further into trt.
I thought ribavirin had the main impact on neutrophils and interferon had a secondary effect. The Soza paper and many others I came across indicate that interferon has the pirmary effect on neutrophil count reduction with only a small if any effect by ribavirin.
Patient neutrophil counts as a function of time into treatment also support this. If ribavirin was the primary cause then it would take 4 or more weeks before neutrophil counts were impacted.
I was supposed to do a shot tuesday, however got bloodwork done today and anc is 620, Doc says to take neupogen tonight (I did, the neupogen is 300mcg, im ~130lbs) and get more bloodwork done on thursday, and then he'll call friday with whether or not to take the shot or not. So here I am, waiting, again. Arggg!
3 so I did the neupogen on Wednesday morning and did my interferon on Friday morning as usual. From what I can tell the neupogen works fast and then leaves my system just as fast.
I let the neupogen sit out for about 15 to 20 minutes and don’t shake it b/c it’s syrupy compared to the interferon and the bubbles that come from shaking won’t leave so you’ll have to throw away that vial.
Mouse: are you saying platelets of 60 or 60,000? Dose reduction of interferon is not usually required until you dip to 50,000.
Budity: It's not weird to have you in for extra monitoring if you are crashing. I lasted a little longer than you before going south, but not much. It took 5 1/2 mos. to stabilize HGB and neutrophils but my platelets are still crashing.
If you have access to rescue drugs.
The one thing I learned from both his old posts as well as OHs is how tricky the timing can be with Neupogen. I knew out the outset to be vigilant about the timing of my labs and the Neupogen dose. Even though this was only weeks ago I see I saved myself some time and discomfort since I knew what to ask and what to look for when I started this med.
I did the Interferon shot on Friday eve and on the following Monday my ANC we usually around 0.3. After the neupogen shot on Monday, my ANC was usually around 0.5 on Thursday - sometimes higher prior to next neupogen shot. However, I was going to a cancer treatment center and the hematologist’s threshold was 1.0, and wasn’t interested in hearing about the lower risk of infection for HCV patients. I saw this pattern repeat throughout the remainder of tx, 0.3 on Mondays, above 0.
thank you
Answer
Hi, Neupogen acts as a granulocyte-colony-stimulating factor and is known to cause thrombocytopenia. Basically neupogen can enhance the phagocytic ('cell eating') activities of neutrophilic leukocytes (white blood cells), including activity directed at autologous platelets. Neupogen can stimulate white blood cells to the point that they can attack the platelets in the blood, causing the low platelet count.
Ok so I've been on cephalaxin for 10 days, went off for 1 day, and now infection is back so skin doctor wants me to do another 10 days. Just got blood test results, neutophils are around 600, so doc doesn't want me to take shot until I have more blood work done. I am ten weeks into treatment, and I don't understand why neupogen isn't an option. I go for my twelve week test in two weeks and am already nervous about that.
frankly, we dont really know how interferon works to battle HCV--it boosts the immune system in some manner and is unrelated to its affects on any WBC.
The doctor notified me the morning before a my business trip. I took the neupogen shot right before I left for the airport and when I landed I started to feel I'll. What I don't know is if I got the flu traveling since my WBC was so low, or if the nuepogen caused my sx.
Also the first time I tool neupogen I was ok? Is it normal to have those severe side effects?
I'm very scared because I don't think I could endure that sickness again.
My doctor used the 500 neutrophill count as a cut-off, so every time I got down around 500 I used Neulasta. The interferon drops neutrophils and platelets. Some people can do okay with low neutrophils but just as many end up with kidney and sinus infections, etc., that make you even more miserable. You may want to start the approval process with your insurance company now, to avoid any delay if you need to add the rescue drug at your next visit.
Some doctors recommend a dose reducing interferon, while others prefer neupogen to avoid a dose reduction. Most doctors actually look at the absolute neutrophil count (ANC) which is a better measure of the risk of infection. This number should be available on your CBC results and its good to monitor this throughout tx, along with your Hgb and platelets. Do you know what your ANC is?
Many docs have a tendancy of overprescribing neupogen (in my opinion), with some having a threshold of 1.
I also had a history of low wbc counts going in and I only got maybe three shots of neupogen the entire treatment. I was a particularly severe, kind of worst case scenario patient.
I know you're really scared of the rescue drugs, and I know that treatment is scary. In my case, it was the reverse, I was terrified of the treatment drugs, the interferon (peg) shot specifically, and not the rescue drugs, because I was already ON one of the rescue drugs.
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