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Hep C Discussion Forum -> On Treatment -> Good and Bad news on 2 week labs (Sovaldi/Riba)
Post Info TOPIC: Good and Bad news on 2 week labs (Sovaldi/Riba)
Enavigo3891


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RE: Good and Bad news on 2 week labs (Sovaldi/Riba)
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Hey Tig - I am not sure why the PCP said external otitis wouldn't raise my WBC however I too thought it was a bit odd. I didn't get oral antibiotics though - only ear drops. I wasn't even aware something was up. The strange thing about me and ear infections, I used to get them a lot as a kid and never felt them. My mom would take me to the doctor when I started having trouble hearing. I got my first "painful" inner ear infection just a few months ago, in December. I was on 10 days of antibiotics and it went away. I associated this external one due to the fact that I wear a head set a lot at work while on the phone and the ear that's infected is the one that my headset goes on.

 

Hi Darkstar - Thanks for the additional information. I didn't post them but went back and checked my MCV - that number has stayed pretty steady. I know Malcolm previously mentioned the Riba needing time to build up before affecting the HGB however I thought it was noteworthy that on day 15 the HGB was the same as baseline yet 3 days later it had dropped by 1.5 points.

 

I'm getting more labs today so I'm interested to see the results of those. Thanks again everyone for your input.



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Born HepC + in 1983 ... diagnosed @ age 13 ... GT2 ... 12 wks of Sovaldi/Riba from 2/11/14 to 5/5/14  #ribazombie

1/30/14 - Starting VL 1,922,967 * 3/11/14 - UND @ 4 wks * 7/29/14 - SVR12 * 11/6/14 - SVR24 * May 2015 - SVR52 * MAY 2016 - STILL UND * FEB 2018 - STILL UND

 
darkstar


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A lot of interesting interpretation.  First, the anemia from ribavirin is due to hemolytic anemia.  Blood levels of ribavirin are "built up" after two weeks, but ribavirin induced hemolytic anemia is a relatively slow process, so hgb is normal after two weeks.  MCV goes up because during hemolytic anemic there is an increased production of young red cells which have higher MCV.  The RDW is not significantly different between times

 

In regards to the white count, in the setting of leukemia (acute) WBCs continue to rise, not go down three days later.  Other parameters are elevated because WBC is elevated.  A normal platelet count is just that, normal.  Variation within the normal range is irrelevant.  Chronic leukemias do not cause a WBC to change that quickly. Ear infections can but may not be associated with an increased WBC.  

 

Hope that helps.



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Tig


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Enavi,

I'd like to know why they said external otitis (bacterial origin) or external ear infections can't possibly raise your WBC's? I'm an old pro at external ear infections and at their worst, guess what? Raised white counts, every time. If there is an active bacterial infection, it can raise your white count. I was treated with antibiotics, the infection was controlled and the WBC returned to normal. This happened to me numerous times. I'm very happy to hear that your ears are feeling better. Nothing hurts quite so bad as a ear infection (shuddering now). I had two of them post EOT in Dec., they were related to Riba caused skin problems in my ear canals, the skin got so dry and cracked that they bled and infected. Keep them lubricated, just a dab of Nivea or the like helps greatly.

Tig



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Tig

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Enavigo3891


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Thanks Malcolm!  And I know I really don't have Leukemia but really, if you look up each individual part of the CBC and look at those lists that say "If this is high then you may have this..." or "Low ____ can indicate this..."  It's insane. If I were one of those people who self diagnosed off WebMD I would probably have an oncologist appointment by now.

As for the dehydration possibly contributing to the WBC issue - it's a possibility. I try to drink.. A LOT ... and have been gauging how hydrated I am but whether I don't get a head ache or how dry my lips/mouth start to get. I figured out early on that I get nasty headaches on days I do not drink enough. I was also super stressed on the 2/25 test. Stressed about work and stressed about what the results of that test may be. I definitely think it was stress/hydration related.  We shall see what happens.



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Born HepC + in 1983 ... diagnosed @ age 13 ... GT2 ... 12 wks of Sovaldi/Riba from 2/11/14 to 5/5/14  #ribazombie

1/30/14 - Starting VL 1,922,967 * 3/11/14 - UND @ 4 wks * 7/29/14 - SVR12 * 11/6/14 - SVR24 * May 2015 - SVR52 * MAY 2016 - STILL UND * FEB 2018 - STILL UND

 
mallani


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Hi Kristen

Firstly, you don't have leukaemia!  Lymph means lymphocytes, and these are given as a whole number, or as a percentage of the total white cell numbers. They are not important, so forget them.

RDW is Red cell Distribution Width. It's a confusing term, so ignore it. It means the red cells vary in size. A more meaningful result would be the MCV, which is the size of the red cells. These always get bigger in the Riba anaemia.

Your platelets are normal-forget about them. Your RBC and Hb will drop as the Riba anaemia kicks in.

The 'Absolute Grans' part is a silly way of saying Neutrophils. Yours may be a bit raised from the ear infection.

I suspect you were a bit underhydrated on the 25th Feb, and this can give misleading results. It probably explains your rather high WBC.  Unless a fasting test is requested, try to drink plenty of fluids, or at least, have the same amount of hydration.



__________________

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
Enavigo3891


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UPDATE: Good and Bad news on 2 week labs (Sovaldi/Riba)
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I followed up with my Primary Care Physician on Friday 2/28 regarding the elevated WBC - they ran a bunch more tests. Told me that I had an outer ear infection in right ear but that wouldn't likely raise my WBC. Got my results today when I called in this morning - the nurse said "you're negative for a UTI (I already surmised as I had no symptoms but wasn't going to argue the test) and doc wants you back in 2 weeks for a follow up CBC". She almost hung up on me before I could get my specific WBC count from her - good news is it went down to 12.0. That's still high but I guess not high enough for doc to send me to a hematologist (plus it is decreasing). Then I got home and logged into my online access to my labs and saw other results that I didn't know to ask about and got me somewhat curious/concerned now. I am aware of the disclosure about not giving medical advice but curious on others own experiences or opinions. 

RDW is going down - good or bad?

RBC is going down - good or bad?

Platelets went WAY down in 3 days - related to the HGB?

Lymph is low - i tried to look this up but I'm not really sure I get what it is.

Side notes: looks like my HGB is finally dropping. I will go back to lab tomorrow for another CBC w/differential as it will be exactly 1 week since the test with high WBC. Then I follow up with my Liver PA a week from tomorrow for my end of week 4 visit and end of week 4 labs.  Needles ... needles... more needles...

 

PS - I have decided that this day and age of having access to your own labs in combination with access to the internet can be both good and bad. If you ask me to interpret my own labs - I am convinced I have leukemia.

 

 

TestNORMAL1 YR PRE-TX BASELINE End of Wk 2 Re-check Wk2 
  03/01/2013 01/30/2014 02/25/2014 02/28/2014 
WBC4.1 K/uL 10.7 K/uL7.90 9.50 15.90H12.00H
RDW12.2 16.3 %13.60 13.40 12.70 12.30L
RBC3.72 M/uL 4.93 M/uL4.35 4.51 4.50 3.94 
Platelet153 K/uL 376 K/uL293.00 318.00 376.00 288.00 
HGB11.1 gm/dL 15.0 gm/dL13.10 13.20 13.50 11.90 
Lymph25 40 %32.00     24.10L
Absolute Grans1.5 K/uL 8.40 K/uL      8.70H


-- Edited by Enavigo3891 on Monday 3rd of March 2014 11:51:38 PM

__________________

Born HepC + in 1983 ... diagnosed @ age 13 ... GT2 ... 12 wks of Sovaldi/Riba from 2/11/14 to 5/5/14  #ribazombie

1/30/14 - Starting VL 1,922,967 * 3/11/14 - UND @ 4 wks * 7/29/14 - SVR12 * 11/6/14 - SVR24 * May 2015 - SVR52 * MAY 2016 - STILL UND * FEB 2018 - STILL UND

 
mallani


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RE: Good and Bad news on 2 week labs (Sovaldi/Riba)
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Hi Kristen,

It takes a while for Riba to reach optimum blood levels, so don't worry about the lack of anaemia yet. The WBC level is a worry- I would repeat it to exclude Lab error. Liver disease or Sovaldi do not raise WBC levels. Best to get it checked out by an Haematologist. 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
AngieV123


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I always have a slightly higher wbc count and I always assumed it was due to my body trying to fight hcv. I'm always asked if I was recently ill. It's been that way for over a decade so I think if I had something serious it'd show by now. I also read all the scary causes of elevations. Hopefully, you are just fending off some illness and that is all.

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Type 1a. Had HCV my entire life via blood transfusion. Did peg & riba in 2000, relapsed. Did triple tx with sovaldi in early 2014 & I am now undetected 
Enavigo3891


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Hi all,

I went to lab yesterday for my 2 week (day 15) blood draw - CBC only, no VL and my doc called me at 8:20am this morning with the results. He stated that the good news is my Hemoglobin did not drop, it actually went from 13.2 to 13.5. (I questioned of course if this is actually good news). I asked if that mean the riba wasn't working - he said not to worry about that. He said he was concerned however as my WBC count shot up. He asked if I had gotten sick or was experiencing any flu like symptoms. I don't think I am. I explained what sides effects I was feeling but prefaced that with the uncertainty of being able to delineate sides from possible elevated WBC count related sicknesses.

As of my baseline testing on 1/30/2014 my WBC count was 9.5 (Normal Range: 4.1-10.7) and by 2/25/14 it jumped to 15.2.  He said that I needed to see my Primary Care doctor as soon as possible as the treatment should not be raising my WBC nor would an elevated WBC be indicative of a liver problem (with all other labs fine).  I am trying not to freak out but of course the Google results for elevated WBC include words like "Leukemia" and the like. I am trying to tell myself that if it were real serious he would have said "meet me at the hospital" and not "make an appointment with your PCP" but still.... bugging out a little.

Anyone else have random elevated WBC counts during treatment with no "infection" type symptoms?

 



-- Edited by Enavigo3891 on Wednesday 26th of February 2014 11:44:20 PM

__________________

Born HepC + in 1983 ... diagnosed @ age 13 ... GT2 ... 12 wks of Sovaldi/Riba from 2/11/14 to 5/5/14  #ribazombie

1/30/14 - Starting VL 1,922,967 * 3/11/14 - UND @ 4 wks * 7/29/14 - SVR12 * 11/6/14 - SVR24 * May 2015 - SVR52 * MAY 2016 - STILL UND * FEB 2018 - STILL UND

 
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