Bloodwork is Low at 1 yr Ann

leo · Site Admin Joined: 23 Sep 2004 Posts: 1574

Very interesting topic ! Just woke up after a long call yesterday....

Anyway, the timing and which blood tests to do are very variable, as you have posted. My personal bias would be to #1 only get blood tests if the patient has received radiation or chemotherapy, since that is going to be a really low risk patient for metastases. #2 do a decent physical exam with every follow-up visit: including heart, lungs, all lymphonode areas, breast exam and abdomen would be the standard. #3 for those who received chemotherapy and/or radiation, those should probably get blood work done, as these patients are certainly higher staged. With that I'd be looking for: anemia, low platelets, low white count. Liver abnormalities, Kidney abnormalities and calcium levels with alkaline phosphatase looking for possible bone lesions. If a tumor marker was obtained prior to treatment, that could be followed as well. If a person is receiving erythropoietin (i.e. Procrit and others) to boost their hemoglobin, that also needs to be followed to adjust the dose carefully.

I hope this was useful. The bottom-line is that patients that receive different treatments and different stages are followed up very differently.

best regards to all !

Leo
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Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

penelopez · Senior User Joined: 11 Oct 2004 Posts: 165

It seems that the bottom line for me is that I should have received some decent follow-up - bloodwork or something, lymph nodes checked, whatever. And I didn't. Mad

I did have the chemo, rads etc.

Nancy and Lauri ~ Thanks for all your kind encouragement. Often we know what we should do but we just need a little nudge from someone else to get moving. I'm looking around (via the internet) for a new oncological group but I will not schedule any appointments until after I meet with my new radiation oncologist on January 12. I'm hoping he'll be honest with me. I will keep you guys updated!

Dr. Leo ~ You should come on over this way when all your training is done. We can sure use some good doctors over here! Smile

L & H,

Margie

jayne · New User Joined: 19 Dec 2004 Posts: 8

I am over 3 years out from chemo and surgery. My blood counts to this day are still low. My onc says this is the new norm for me.
Jayne

Divine1 · Posted: Sun Dec 19, 2004 2:45 pm Post subject: blood drawn

Margie,
I wanted to say to you everytime to go to the Onco, they draw my blood to check my levels.
IThey also flush my port while Iam in their office.
With My count being so low and having Pocrit to help boost it up.
I have have had many Blood Transfusions to help bring up my count.
After I have had my Chemo it had ripped through my system and whipped me out, Today Iam still have problems keeping up the count..

But Iam still trying to figure out why My WBC always drops?
My Absolute Neutrophil is what they look at and mine are : 0.9 so there is a Big drop, the norm are,,1.8-7.8 .
So that is what is going on in my life>
Margie good luck hun and happy holidays.
Tammy
_________________
Tammy 43 yrs old ,Wife to Doug for 25 yrs
Mom to two kids, Comp Hyst 1/90
Ant, Post Fus 10/02,,Cerv Fus 8/03 Dx. Lob B/C 12/18/03 19 nod Neg Stge 2, ER Post. Mast lft w/expan, Rt Mast 6/03 imp. 11-03 Imp Finished .7/03 Arimidex 5 yrs.

penelopez · Senior User Joined: 11 Oct 2004 Posts: 165

Dear Tammy,

It was so sweet of you to wish me luck and Happy Holidays. Thank you so much! I'm sure I'll be fine and get this entire mess "fixed" eventually.

In the meantime, you are in my thoughts and prayers and I am hoping that your WBC counts go up very soon. Also, I wanted to wish you:

Happy birthday to you
Happy birthday to you
Happy birthday dear Tammy
Happy birthday to you!

You said your birthday is on the 20th and I hope you have a FABULOUS day! Let your family treat you and "spoil" you - you deserve it!

Happy Holidays!

Hugs,

Margie

Divine1 · Posted: Sun Dec 19, 2004 4:20 pm Post subject: Margie

Thankyou Margie,
I want to Thankyou from the Bottom of my Heart.
How wonderful for you to give me a a big Birthday Celebrate..

Hugs to you,,,, I am with you every step pf you journey. God Bless

Love,
Tammy
_________________
Tammy 43 yrs old ,Wife to Doug for 25 yrs
Mom to two kids, Comp Hyst 1/90
Ant, Post Fus 10/02,,Cerv Fus 8/03 Dx. Lob B/C 12/18/03 19 nod Neg Stge 2, ER Post. Mast lft w/expan, Rt Mast 6/03 imp. 11-03 Imp Finished .7/03 Arimidex 5 yrs.

AlaskaAngel

Dr. Leo,

Question 1: What is really known about the long-term effects? On a personal basis I am having problems with chemobrain at 2 years post-treatment and I wonder if it is due to prolonged oxygen deprivation in the brain from low blood counts. To me this is a very logical question to ask.

I sent my CBC results to my onc's nurse and she spoke with him about them. He indicated that he was happy with my blood counts. The CBC, WBC, Hb and Hct are all below the bottom of the normal range.

Question 2: Is it true that for the most part there is no way to really change that and bring those counts back up into a normal range?

leo · Site Admin Joined: 23 Sep 2004 Posts: 1574

AlaskaAngel,

About chemobrain I answered in a different post.

About your blood counts, after chemo, many times your counts will be low chronically, because of the effects of chemo on the bone marrow.

best regards,
Leo
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Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

AlaskaAngel · Posted: Thu Dec 23, 2004 1:17 pm Post subject: Low blood counts

Dr. Leo,

Thank you yet again for your honest answers.

Like my onc, I know you see many patients with problems that are a lot more serious than just long-term low blood counts, and if I am wasting time here for both of us I know you will move on to others and neither of us will take it personally.

I think that the tendency is natural to acknowledge and then more or less dismiss as "common" or "natural" the chronic low blood counts of cancer patients who have been through chemo.

But those counts mean something more significant than that if those of us with low blood counts end up having a recurrence and having to start off again in treatment with low counts. Is very much known about how much chronic low blood counts affect subsequent treatment results?

This seems like common sense to me, but in spite of seeing many, many posts from women about this question, the only response I've seen is that we should just expect to have low blood counts.

Is there any medical advice about how to raise them? Or hasn't anyone really thought about it?

A.A.

Muttsmom · Posted: Thu Dec 23, 2004 1:31 pm Post subject: Re: Bloodwork is Low at 1 yr Ann

Hi
I don't have an answer for you, but I'm curious about something. There are a couple things on my labs that are a little off, but not even sure what they are. My white and red counts are normal. My onco checked labs a week after my 1st chemo, then 2 weeks and then the 3rd week, which was my next chemo. Based on that, it showed that where my counts bottomed out like they do with chemo, they built themselves back up to normal. I never had to have procrit or the one for white counts. What I'm wondering is I know some oncos give the shot for white counts regardless if they are needed or not and some only give it if needed. Is there any connection to getting those shots through chemo to where your body counts on them to keep them "normal". If so, is it only when you get them when needed or when you get them regardless.
I've always wondered why ladies got the shots for white count if they rebounded on their own and never went below what is expected while taking chemo. Again, I don't know the answers and I don't know if you got them through chemo because you needed them, as routinely or neither. I guess I'm trying to through out things and see if anything comes together for you.
Hugs and I hope you get the answers soon. I know the not knowing is always hard and through this journey, we learn so much, but still know so little.
Nancy
_________________
Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

DiO · Posted: Thu Dec 23, 2004 9:19 pm Post subject: low WBC

Hi Nancy!

The reason my onc gave me the Neulasta WBC booster routinely was in order to get the counts back up in time to do the next treatment of dose dense chemo in two weeks instead of three. Studies are showing this is a little more effective than the normal 3 week schedule. The procrit I only got when needed. Interestingly my RBC is now normal, but my WBC is low 8 months out from chemo.
_________________
God Bless, Di

IDC 12/03 at age 55
lumpectomy, SNB 12/18/03
2cm tumor, 1/6+node, stage 2, grade 2 er/pr+ her2nu-
4 AC, 4 taxol, dose dense
33 rads
Arimidex started 7/04

leo · Site Admin Joined: 23 Sep 2004 Posts: 1574

AA and all,

First of all, you are not wasting my (or our) time at all. I feel it is important to try to address everyone's concerns as much as I can. While chronic low counts are not uncommon, they can cause problems.

Having low blood counts can mean a lot of things. Basically there are three major groups of blood cells: red cells, white cells and platelets. When you get chemotherapy, different drugs affect different cell groups.

Your white count can get low, and if it stays too low for some days one may need something like Neulasta to boost your white cells. This type of drug will NOT improve platelets or red cells, white cells only. They are responsible for fighting infection.

There is no drug that can boost platelets (yet). This may come soon.

One can also become anemic after chemotherapy. That can be corrected with transfusions and/or erythropoietin (Procrit).

Any of the blood cells can become chronically low. Can it cause problems ? Yes. For future chemotherapy, the doses may need to be adjusted. Some drugs might need to be omitted. If the white count stays low, it can predispose one to infections.

These are general remarks. There are no clear guidelines for that.

best regards,
Leo
_________________
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

Marion · Experienced user Joined: 28 Nov 2004 Posts: 60

All, my onc has me taking a shot of Neulasta with each chemo treatment because he feels the chemo is more effective if I can stay on a two week regimen. If the WBC count gets low he was going to push it to every three weeks. I have to say with each treatment so far (I just finished my 3rd), my WBC has stayed high and only dropping slightly. As he explained to me the WBC will start to drop after chemo and the Neulasta will kick in at some point to start to elevate it. I'm not sure if my onc's thinking is the norm but it seems to be working for me so far.

Merry Christmas to everyone and best healthy wishes for the new year.

Marion

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