INFO: WBC - White Blood Cells - Count - Differential - What happens when your white cells are to low on treatment?

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Here's an explanation of neutrophils, hope it helps. I'll check & see I have anything else you need.SuZie What are white blood cells? White blood cells, also called leukocytes, are cells that your body makes to help fight

infections. There are several kinds of white blood cells. The two most common types are lymphocytes and neutrophils. Neutrophils are also sometimes called granulocytes or polymorphonuclear leukocytes (PMNs or "polys"). A white blood cell count (WBC) is performed by counting the number of whiteblood cells in a sample of your blood. A normal WBC is in the range of 4,000 to11,000 cells per microliter (mm3). W.B.C. (White Blood Cell Count) Normal Adult Range: 3.8 - 10.8 thous/mclOptimal Adult Reading: 7.3Higher ranges are found in children, newborns and infants. What are

lymphocytes? Lymphocytes come from your lymph tissue (spleen, lymph nodes, thymus gland). There are different kinds of lymphocytes, including CD4 cells (T-helper cells) andCD8 cells (T-suppressor cells). Lymphocytes identify foreign substances frombacteria or viruses in your body and produce antibodies and cells that specificallytarget them. It takes from several days to weeks for lymphocytes to recognize andattack a new foreign substance. What are neutrophils? Neutrophils are a major part of your body’s defense against bacterial infections. When the WBC is low, there may not be enough neutrophils to defend you againstbacterial infections. Neutrophils are made in the bone marrow and circulate in the bloodstream. Neutrophils move out of the blood vessels into the infected tissue to attack thebacteria. The pus in a boil (abscess) is made up

mostly of neutrophils. Normally aserious bacterial infection causes the body to produce an increased number ofneutrophils, resulting in a higher than normal WBC. A normal absolute neutrophil count (ANC) is in the range of 1,500/mm3 to8,000/mm3. If the ANC is below 500/mm3 for an extended period of time, your risk of serious bacterial infection may increase significantly. A low neutrophil count is also called neutropenia. White blood cells main function is to fight infection, defend the body by phagocytosis against invasion by foreign organisms, and to produce, or at least transport and distribute, antibodies in the immune response. Granulocytes Nongranulocytes Band Neutrophiles Lymphocytes Neutrophils Monocytes Eosinophils

Basophils Each cell, or leukocyte, has a different job in the body which is explained in the Differential section. Differential NEUTROPHILS and NEUTROPHIL COUNT LYMPHOCYTES and LYMPHOCYTE COUNT MONOCYTES and MONOCYTE COUNT EOSINOPHILS and EOSINOPHIL COUNT BASOPHILS and BASOPHIL COUNT NEUTROPHILS and NEUTROPHIL COUNT Also known as Granulocytes or segmented neutrophils, this is the main defender of the body against infection and antigens. High levels may indicate an active infection, a low count may indicate a compromised immune system or depressed bone marrow (low neutrophil production. Normal Adult Range: 48 - 73 %Optimal Adult Reading: 60.5Normal Children’s Range: 30 - 60 %Optimal Children’s Reading: 45

LYMPHOCYTES and LYMPHOCYTE COUNT Lymphocytes are involved in protection of the body from viral infections such as measles, rubella, chickenpox, or infectious mononucleosis. Elevated levels may indicate an active viral infection and a depressed level may indicate an exhausted immune system or if the neutrophils are elevated an active infection. Normal Adult Range: 18 - 48 %Optimal Adult Reading: 33Normal Children’s Range: 25 - 50 %Optimal Children’s Reading: 37.5 MONOCYTES and MONOCYTE COUNT

These cells are helpful in fighting severe infections and are considered the bodies second line of defense against infection and are the largest cells in the blood stream. Elevated levels are seen in tissue breakdown or chronic infections, carcinomas, leukemia (monocytic) or lymphomas. Low levels are indicative of a state of health. Normal Adult Range: 0 - 9 %Optimal Adult Reading: 4.5 EOSINOPHILS and EOSINOPHIL COUNT Eosinophils are used by the body to protect against allergic

reactions and parasites. Therefore, elevated levels may indicate an allergic response. A low count is normal. Normal Adult Range: 0 - 5 %Optimal Adult Reading: 2.5 BASOPHILS and BASOPHIL COUNT Basophilic activity is not fully understood but it is known to carry histamine, heparin and serotonin. High levels are found in allergic reactions, low levels are normal. Normal Adult Range: 0 - 2 %Optimal Adult Reading: 1 What happens when your white cells are to low on treatment? People taking the 1.0 and 1.5mcg/kg dose of peg-interferon experienced slightly more side effects than those on the other two doses. The most common side effects included headaches, fatigue, flu-like symptoms, depression, and decreases in white blood cell counts, platelets (cells needed for blood-clotting) and neutrophils (a type of white blood cell that helps control bacterial and other infections). What causes a low neutrophil count? Neutrophils die continuously from age or from fighting infections, and your bonemarrow must make new neutrophils to replace them. When something reducesproduction of neutrophils in your bone marrow, the neutrophil count will drop andmay become dangerously low. Prescription medications, such as trimethoprim-sulfamethoxazole (TMP-SMX,Bactrim, Septra), ganciclovir, zidovudine (AZT), interferon, pyrimethamine,primaquine, and many chemotherapy agents used for Kaposis' sarcoma andlymphoma are common causes of neutropenia. In almost all cases, drug-inducedneutropenia (low white count) resolves after the agent is stopped or its dosage is reduced. Drugs that Help Low White Count Neupogen (G-CSF): a colony stimulating factor (CSF)that signals the bone marrow to increase output of white cells (specifically neutrophils), which help to fight bacterial infections. Neulasta: a protein that stimulates the production on white blood cells. Neutropenia during combination therapy of Interferon and Ribavirin Soza, E. Everhart, Marc G. Ghany, Doo, Theo Heller, Kittichai Promrat, Yoon Park, T. Jake Liang, and Jay H. Hoofnagle Interferon therapy of hepatitis C causes a decrease in neutrophil counts, and neutropenia is a common reason for dose adjustment or early discontinuation. However, it is unclear whether neutropenia caused by interferon is associated with an increased rate of infection. In this study, we assessed factors associated and clinical consequences of neutropenia before and during interferon therapy of chronic hepatitis C. A total of 119 patients with chronic hepatitis C treated with the combination of interferon alfa and ribavirin were analyzed. In these studies, neutropenia was not used as an exclusion or dose modification criterion. In multivariate analysis, only black race was associated with baseline neutropenia. During treatment, neutrophil counts decreased by an average of 34%. Among 3

blacks with baseline neutropenia without cirrhosis or splenomegaly, there was little or no decrease in neutrophil counts (despite typical decreases in platelet and lymphocyte counts). Documented or suspected bacterial infections developed in 22 patients (18%), but in no patient with neutropenia. United States population estimates suggest that 76,000 blacks with hepatitis C have neutrophil counts below 1,500 cells/ L and might be denied therapy if this exclusion criterion was generally applied. In conclusion, neutropenia is frequent during treatment of hepatitis C with interferon and ribavirin, but it is not usually associated with infection. Constitutional neutropenia, which is common among blacks, should not exclude patients from therapy with interferon as these patients usually have minimal further decreases in neutrophil counts on therapy and are not excessively prone to bacterial infections. HEPATOLOGY 2002;36:1273-1279.) Neutrophil counts can fall to levels that are associated with an increase in risk of bacterial infections and sepsis. Indeed, in the recent large randomized con- trolled trials of pegylated or standard interferon combined with ribavirin neutropenia was listed as the most common reason for dose reduction (18% of patients) and was a reason for early drug discontinuation in 1% of patients. Furthermore, most studies have excluded patients with preexisting neutropenia ( 1,500 cells/ L). This exclusion criterion has major implications for select population groups with hepatitis C. Neutropenia is more common among black patients than whites and a larger proportion of blacks are excluded from trials of therapy of hepatitis C for this reason. Whereas the consequences of neutropenia are believed to be substantial, there is little evidence for adverse clinical implications of neutropenia induced by interferon particularly in patients with preexisting low white cell counts. At the Clinical Center of the National Institute of Health, clinical studies of therapy of hepatitis C have not used neutropenia as an exclusion criterion. We retrospectively have analyzed neutrophil counts during therapy of hepatitis C and occurrence of bacterial infec- tions. The effect of using neutropenia to exclude potential patients from treatment was determined among white and black participants in the Third National Health and Nutrition Examination Survey (NHANES 3). Below is an excerpt from the study found at the url listed below: In this analysis of neutrophil counts among 119 pa- tients treated at a single referral center, neutropenia was not used as an exclusion criterion and therapy was safely accomplished despite decreases in neutrophils below the usual levels that lead to dose reduction or drug interrup- tion. Bacterial infections did not occur in neutropenic patients, and the only severe infection that was identified occurred in an elderly patient with preexisting cirrhosis. Of potential interest, the only baseline measure that pre- dicted subsequent infection was low

reticulocyte count. We are unaware of other information linking reticulocyte count to subsequent infections. Nevertheless, the associ- ation was strong and deserves further investigation. There was poor correlation between total white blood cell count and neutrophil count in patients with neutro- penia, indicating that measurement of absolute neutro- phil count instead of total white blood cell count is necessary in monitoring therapy. Of greatest importance, 3 patients were treated who appeared to have constitu- tional neutropenia, marked by persistently low neutrophil counts (below 1,500 cells/ Click below to read the study in its entirety; PDF]Neutropenia During Combination Therapy of Interferon Alfa and ... File Format: PDF/Adobe Acrobat - View as HTML... information linking reticulocyte count to subsequent infections. ... marked by persistentlylow neutrophil counts ... typical increases in neutrophils during bacterial ... hepcvets.com/info/2002/nov/hepcinfo1273.pdf - http://janis7hepc.com/monitoring_our_blood_work_while.htm#what%20are%20red%20blood%20cells

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