Neutrophils

[felly]

I have had three sessions of chemotherapy following a mastectomy and axillary clearance for breast cancer. My Neutrophils before I started were 5.1, went down to 4.1 after the first session and down to 2.0 after the third. I understand if they go down to one or less my last session will have to be delayed. Has anyone had a similar experience. I really want to get the last session done on time but it seems quite likely that this might not happen. Any advice would be appreciated.

[LazyGun]

Hi felly,

Cannot give you any direct personal experience. I assume you are aware of the reason for monitoring the neutrophil count, which is used as a measure of your risk of contracting a serious, opportunistic infection resulting from your immune systems impaired ability to fight infection.

This impairment of the system is one of the unfortunate unintentional side-effects of chemotherapy - the suppression of cell division in stem cells, leading to a reduction in the production of white blood cells, red blood cells, and platelets.

This impairment is, however, temporary - Were your neutrophil count to drop much further, the risk of a serious,opportunistic infection would greatly outweigh the therapeutic benefit of pressing ahead with the dose of chemotherapy. The main consolation is that such side effects are temporary, and rebounds reasonably quickly, so, were your chemotherapy session delayed, it should not be for much more than 2-3 weeks.

You may find some of the information presented in this link helpful.....

http://www.chemocare..../low_blood_counts.asp

[felly]

Thank you LazyGun for your very helpful answer. I am pleased to hear that if there is a delay in my last session it won't be for too long. I've had a look on the link but got very confused as there is so much information and I can't relate the figures to the ones I've been given. My Neutrophils are 2.0, my Hb is 12.2 which I'm told is good. My WBC is 4.6 and my Platelets are 249. Have tried multiplying my Neutrophil count by the WBC but get 9.2 so can't relate it to the table which goes from 1500 to 100. I am probably not understanding but feel better from reading your answer so thank you.

[Euphemia]

Looking at my chemo record, I note that my Neutrophils was 1.98 on my eleventh session. My following and final session did not proceed because of kidney damage

[felly]

Oh dear Euphemia. Was the kidney damage permanent? Hope you are OK now. Best wishes.

[Euphemia]

The kidney function is now much improved, thank you. Best wishes

[LazyGun]

Hi felly - Its different scales and measuring/ reporting systems that cause the confusion ;)

The reported reference ranges have changed with time and country, and can sometimes be confusing, I am sorry to say ;) The table I linked to offers a selection of results based upon a different reported reference range than your own values, which can be confusing.

With respect to your own results - Your Hb of 12 is fine, as is the platelet count of 250ish.They seem to be reasonably refractory to your treatment at the moment, which is good.

The values you quote in your OP ( 5.1, declining to 4.1 and then to 2.0) I assume represent your Absolute Neutrophil Count, which has been derived from your own total white cell count x your percentage of neutrophils. Your own neutrophil levels have dropped to around 40% of their starting level ( 2.0 after the third session, compared to 5.1 prior to chemotherapy), and if they dropped to 1 or less that would place you at serious risk of opportunistic infection.

If you look again at the link I provided you, divide the number they quote by 1000 to get the more relevant comparison for you.

Using the reference ranges your results have been quoted in, the categories in the table in the link would read " ANC greater than 1.5" , "ANC 1.0-1.5" , "ANC 05.-1.0", "ANC 0.1-0.5", "ANC less than 0.1"

I hope that makes things clearer! :)

[felly]

Thanks LazyGun. I did wonder if I should add some noughts to my result just didn't know how many but I'm still confused. If use the 9.2 result I got from multiplying my WBC of 4.6 by Neutrophils 2.0 the resulting figure seems far too high so maybe I should be using the Neutrophils figure of 2.0 in which case I still seem to be in a category of no increased risk. Or then again I might just have no idea what I'm doing :) Maybe should have asked my Oncologist but he is even more confusing!

[LazyGun]

Felly,

I can understand your confusion ;)

You have already been given your Absolute Neutrophil Count. It is 2.0, against a total White Cell Count of 4.6. In other words, that calculation mentioned on the link I offered you has already been done for you.

So, converting your count to a reference value matching that table in the link, your current ANC of 2.0 would convert to around 2000 - so no increased risk of infection. If however your ANC ( Absolute Neutrophil Count) drops to around 1.0 or less (which would convert to 1000 or less according to the ranges offered from the link), that would drop you into the moderate to high increased risk of infection.

I hope that clarifies things ;)

[felly]

Definitely LazyGun. Totally get it now and am a happy bunny. Thanks again for all the help.

[anneasquith]

felly. i recall a post from you a while back re your diagnosis, im happy to see you r nearing the end of your treatment, re lazygun................ as usual excellent advice :)

[felly]

Thank you anneasquith for thinking of me. One more dose of chemo and then I go on to Herceptin infusions every three weeks for a year or just 6 months if I'm lucky as I'm taking part in a trial. Hopefully should cope with the Herceptin OK as it doesn't have so many side effects as the chemo which I have found a bit difficult to cope with and it doesn't kill off your good cells either.

[anneasquith]

good luck felly. im sure your treatment will be worth it, take care .