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Hep C Discussion Forum -> On Treatment -> thrush again, low WBC
Post Info TOPIC: thrush again, low WBC
mallani


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RE: thrush again, low WBC
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Hi Brendalee,

Your AST and ALT are normal. If you were Undet. just on Peg and Riba, you probably didn't need the Victrelis, as you are obviously Interferon sensitive. I doubt whether your biopsy was from the L liver lobe- that's almost certainly a misprint, as biopsies are taken from the R liver lobe. I would ask why my Riba dose was reduced as it has no effect on WBC's, and why are you doing 48 weeks of Rx when 28 weeks is usual. You should get back on your correct Riba dose as soon as possible. If your Hb drops below 10, that's a different story. You are well on your way to SVR if you keep up the correct doses. Cheers.



__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Brendalee333


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 AST 21   
 ALT 35 

 

 

 those results were from 7/11.  I actually told the nurse cuz i seen her at the hospital for a different appt that i want the biospy explained to be more thoroughly.  i asked them if reducing the riba would effect my chance of messing up the treatment and she said no. and yes i was undetected right before i started the vic.  i  see my doctor monday, so what questions do you think i should ask her?



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genotype 1a

Started treatment 4/12/13 with ribavirin and peg-intron. Started Victrelis 6/19/13. (triple therapy)
Brendalee333


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Wbc1.74.2 - 11.0K/mcLL
Rbc3.544.00 - 5.20mil/mcLL
Hgb10.612.0 - 15.5g/dLL
Hct34.936.0 - 46.5%L
Mcv98.678.0 - 100.0fl 
Mch29.926.0 - 34.0pg 
Mchc30.432.0 - 36.5g/dLL
Rdw16.111.0 - 15.0%H
Plt194140 - 450K/mcL

 

Absolute Neutrophil0.71.8 - 7.7K/mcLL
Absolute Lymph0.81.0 - 4.8K/mcLL
Absolute Mono0.10.3 - 0.9K/mcLL
Asolute Eos0.00.1 - 0.5

K/mcL

 

 

L

 

 

 

 

 ok so my copy/paste thing didnt work very well.

and this is my most recent

Wbc2.24.2 - 11.0K/mcLL
Rbc3.344.00 - 5.20mil/mcLL
Hgb10.212.0 - 15.5g/dLL
Hct34.236.0 - 46.5%L
Mcv102.478.0 - 100.0flH

 <my absolute neutrophil is 0.5 on the last lab. .and i started the vic late cuz i had huge insurance issues that we didnt expect would happen.  The doctor said the reduction in riba wouldnt effect clearing the virus, but im worried....now im down to 3 pills of riba a day.  and as my biopsy, on my med mad account this is what it said, im having it explained to me more next week,   Pathologic Diagnosis : LIVER, LEFT LOBE, CORE NEEDLE BIOPSY: 1. PORTAL INFLAMMATION AND MILD PIECEMEAL NECROSIS. 2. MILD FIBROSIS WITH PORTAL EXPANSION. 3. NO INCREASED IRON DEPOSITION. 4. FINDINGS CONSISTENT WITH CHRONIC HEPATITIS C INFECTION, GRADE 2, STAGE 1.    And it is hard to get on and reply,takes me awhile, the girls turned 15 months and are just go go go, into everything! 



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genotype 1a

Started treatment 4/12/13 with ribavirin and peg-intron. Started Victrelis 6/19/13. (triple therapy)
Brendalee333


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yeah I went thru a few bottles of magic mouth wash already and have the biotene. I chew gum alot, thats about all i can do. and drink fluids!!! 



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genotype 1a

Started treatment 4/12/13 with ribavirin and peg-intron. Started Victrelis 6/19/13. (triple therapy)
mallani


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Hi Brendalee,

Sorry, more questions. From your dates, you appear to have done a 10week leadin with Peg and Riba. Also, is it correct that you were Undet. before starting Victrelis? Your biopsy report is A2 F1, so why are you doing 48 weeks? You should only be doing 28 weeks, but with your unusual leadin period, extending it to get 24 weeks of Victrelis seems reasonable.  Your Hb is still OK at 10.2, so why was your Riba dose reduced? Your WBC is also Ok, and as I said in an earlier post, white blood cell reduction is due to Interferon, not Riba. Your platelets are also good, but you haven't given the latest results. Also could you post your latest ALT and AST results? I would be having a please explain visit with my doctor!



-- Edited by mallani on Sunday 15th of September 2013 07:40:12 AM

__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
mallani


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Hi Brendalee,

I've reviewed your posts, and wonder why you don't respond to some of the questions Members ask. I don't mean to be nosy, but it would be useful to know the results of your liver biopsy, what's happened to your high ALT and AST, and what your Hb and platelets are. Your biopsy results must have been significant, if you are doing 48 weeks Rx.  It's difficult to give advice without knowing some basic facts. Like Tig, I wonder why you did a leadin of 8 weeks. Surely Insurance must have approved Rx before your Doctor would let you start. Also we can't give an opinion about Riba reduction without knowing basic things like Hb and platelets.  You were given advice about the dry mouth but have not responded. I know you must be busy with 10 month old twins, but the more info you can give us, the better we can try to help. Cheers.



__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Tig


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Hi Brendalee, I wondered if your Hepatologist explained to you the reason you had an 8 week lead in with Peg and Riba prior to starting the Victrelis? Normally it's 4 weeks. Was it insurance? It just seems like your doctor has some different approaches to treatment and I'd be sure to ask if I were you. It may explain why you're experiencing some of the symptoms you're having. You might also ask your doctor for some Magic Mouthwash for the Thrush, along with some Biotene mouthwash (over the counter) and the salt water rinses for dry mouth. I'm experiencing the same things and they help me a lot! Good luck!



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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Zlikster


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Hi Brendalee,

my hepa was pushing my WBC to 1.4 (neutrophiles to 0.4) then i got 50% reduction in interferon, as Malcolm said Riba is connected with RBC/Hg/PLT drops not with WBC. If your RBC/Hg is ok, don't let em reduce Riba dosage! I had to fight with my hepa not to lower my Riba dose (she won tho) when i reached 107 Hgb (her lower limit is 110, tried to opt in for 100 as limit). I did 3 injections of Neupogen and it's amazing how fast your WBC goes up, but it only last 3-4 days.

all the best





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GT 3 dg. 08-2012 / FibroScan: 5 kPa F1 / FibroTest: F0-1 A1 / SoC TX: PegInt 120mcg+Riba 1000mg UND from w8 relapse EOT+4w
01-2016 Sof+Dac+Riba UND from w8, SVR24!
mallani


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Hi Brendalee,

The drop in white blood cells is almost entirely due to Interferon. I'm not sure why your Riba dose has been decreased.  I would certainly want to get to my proper Riba dose ASAP!  If your WBC count drops to below 1.0, I'd consider a reduction of Interferon, but would probably wait until the WBC count dropped below that. Riba reduction is used for anaemia, not for a moderate WBC reduction. All patients on triple Rx can expect a drop in WBC of 30-40%. Neupogen has been successful in elevating the WBC count, and I would want this before I considered any dose reduction. Do you know your Hb? This may be why you're short of breath.

Rinsing your mouth with salty water is helpful in preventing thrush. Good luck.



__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Brendalee333


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ahh this dry mouth. got thrush for the 3rd time now. this time they gave me a pill antibiotic, and another anyibiotic cuz im kinda sick. my WBC count was 1.7 so they dropped the 5 pills of riba down to 4. then It went up to 2.2 but decided to drop the pill dose to 3 now. weak, short of breath. hope the pill drop doesnt mess with my chance of clearing this!!!  hair keeps falling out...



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genotype 1a

Started treatment 4/12/13 with ribavirin and peg-intron. Started Victrelis 6/19/13. (triple therapy)
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