Guest guest Posted February 14, 2004 Report Share Posted February 14, 2004 Hi Sue, I don't have all the knowledge that or a do, but I am a lab tech and know a little about blood. Your white cell count is a little lower than normal, but not very low. White cell counts can change due to many factors, including medications and illness. Usually, a lower white count, is more typical with viral infections, and higher white counts are more typical with bacterial infections. Granulocytes are the ones that increase in number with bacterial infection. With medication problems, like with people on chemotherapy, the granulocytes are not able to be produced as they should. Since they are the bacteria fighters in your system, that makes a person more susceptible to bacterial infection. I think, your best bet, is to talk to your doctor and let him know you are worried. Ask him what he thinks is too low. If he doesn't give you an answer, call your PCP, and ask him. I don't think you need to be worried at this point, but talk to your doctor. At least you can get some peace of mind that way. Noreen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2004 Report Share Posted February 14, 2004 Sue, I agree with Noreen's advice - ask your rheumatologist about this when you see him on Monday. No, I don't think you are worrying unnecessarily since your WBC count has been depressed for so long now. According to several sources, leukopenia is defined as total white cell counts of below 3700 - 4000 cells per cubic millimeter and neutropenia is defined as a absolute neutrophil count of lower than 1500 - 1800 cells per cubic millimeter (there are some variations depending on the specific lab and the individual). As you know, many things can cause or contribute to low white cell counts, even rheumatoid arthritis itself (it also occurs in the small subset of RA patients who develop Felty's syndrome = RA + splenomegaly + leukopenia). It could be the Enbrel that is keeping your white blood cell count low. There have been a few reports of pancytopenia and aplastic anemia associated with Enbrel therapy, and, since our reporting system is so bad, I'm sure it occurs more often than what has been documented to date. " Hematologic Effects. Rare reports of pancytopenia and aplastic anemia have been ascribed to both etanercept and infliximab (22,23). There have been 15 reported cases of pancytopenia with infliximab and 12 cases of pancytopenia and 4 cases of aplastic anemia with etanercept. A minority of these resulted in death. Cytopenias developed in the first few weeks (median 4 weeks) after initiating TNF inhibitors. Periodic monitoring (every 3 to 6 months) of blood cell counts is advised. Anakinra has occasionally been associated with a 10% to 20% drop in leukocyte counts in nearly 8% of patients. Severe leukopenia was observed in 0.3% of patients, but aplastic anemia has not been reported (6). " http://www.arthritis.org/research/Bulletin/Vol52No8/Safety_Concerns.asp " Etanercept associated with aplastic anaemia " : http://www.ukmicentral.nhs.uk/headline/database/printstory.asp?NewsID=2903 Granulocytes are neutrophils, eosinophils, and basophils. What was your neutrophil count? " Leukopenia " from Best Practice Medicine Professional Reference: http://merck.praxis.md/index.asp?page=bpm_report & article_id=BPM01HE04 & section=re\ port & ss=1 " Granulocytopenia " from eMedicine.com: http://www.emedicine.com/med/topic927.htm I'll tell you where to go! Mayo Clinic in Rochester http://www.mayoclinic.org/rochester s Hopkins Medicine http://www.hopkinsmedicine.org [ ] or a -Lab Results > I had blood work done yesterday in preparation for my rheumy visit, > which will be Monday. My white blood cell count is still low and has, > in fact, gone down from 3.9 to 3.5 (normal 4.0-10.5). The Granulocyte % > and Absolute Gran are lower than normal for the first time. I know that > granulocytes are white blood cells, but that's all I know about them. > > I have been on Enbrel since last March, so the effects of methotrexate > should be gone, but I don't know about the Arava. I've read that Arava > can stay in your body for two years. > > I even had the rheumy switch me from Bextra to Celebrex to see if the > Bextra might be contributing to the low WBC count. > > I know that it's not all that low, but the fact that it persists in > being low is what bothers me. Am I worrying needlessly? Or should I ask > the rheumy to take some kind of action? It might not worry him, but > then it's not his blood cells. > > Sue Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2004 Report Share Posted February 14, 2004 Thanks, Noreen, for your help. I will certainly talk to my doctor about this on Monday. He's been saying it's nothing to worry about, but it's been going on a long time. I did have a couple of stomach viruses right after Christmas, but my WBC count was low before that. Sue On Friday, February 13, 2004, at 11:48 PM, Noreen Saukko wrote: > > I don't have all the knowledge that or a do, but I am a lab > tech and know a little about blood. Your white cell count is a little > lower than normal, but not very low. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2004 Report Share Posted February 14, 2004 Thanks, , for the articles. I will certainly read them, and of course I will discuss this with my rheumy on Monday. Please don't say it could be the Enbrel. LOL! Enbrel is working so well for me. The low WBC count predates the initiation of Enbrel. On Saturday, February 14, 2004, at 04:28 PM, wrote: > > I agree with Noreen's advice - ask your rheumatologist about this when > you see him on Monday. > > Granulocytes are neutrophils, eosinophils, and basophils. What was your > neutrophil count? > The neutrophil count is not given unless it's called something else. The Basophils are 0 (normal 0-1). The eosinophils are slightly high at 7 (normal 0-5), and have been above normal at least since last June, when they were 10. If the rheumy tells me not to worry, I'll try not to. I'll let you know what he says. Sue Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2004 Report Share Posted February 14, 2004 Yes, Sue, I know you didn't want me to mention the Enbrel, but I would be remiss if I didn't. Even though you had the low WBCs before, previously you were on other DMARDs that can cause leukopenia, too (like MTX and leflunomide). How low were your neutrophils? I'll tell you where to go! Mayo Clinic in Rochester http://www.mayoclinic.org/rochester s Hopkins Medicine http://www.hopkinsmedicine.org Re: [ ] or a -Lab Results > Thanks, , for the articles. I will certainly read them, and of > course I will discuss this with my rheumy on Monday. Please don't say > it could be the Enbrel. LOL! Enbrel is working so well for me. The low > WBC count predates the initiation of Enbrel. > > On Saturday, February 14, 2004, at 04:28 PM, wrote: > > > > I agree with Noreen's advice - ask your rheumatologist about this when > > you see him on Monday. > > > > Granulocytes are neutrophils, eosinophils, and basophils. What was your > > neutrophil count? > > > The neutrophil count is not given unless it's called something else. > The Basophils are 0 (normal 0-1). The eosinophils are slightly high at > 7 (normal 0-5), and have been above normal at least since last June, > when they were 10. > > If the rheumy tells me not to worry, I'll try not to. I'll let you know > what he says. > > Sue Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2004 Report Share Posted February 15, 2004 , Did you not see the part of my message below in green? Could the neutrophils be called something else? The granulocyte % was also slightly low at 39 (normal 43-77) and Absolute Gran, also, at 1.3 (normal 1.4-7.7). One of the articles you sent mentioned radiation as a cause. I had 35 radiation treatments following a lumpectomy for breast cancer in 2002. At that time, I was taking methotrexate. So maybe that had an impact. I'll remind the rheumy of that. The radiation oncologist told me that I couldn't take mtx during radiation, but when the rheumy didn't give me an alternative medication, he said I could keep on taking it. This might have been a mistake, but otherwise I could have died from pain. <grin> Thanks so much for your help. Sue On Saturday, February 14, 2004, at 05:10 PM, wrote: > Yes, Sue, I know you didn't want me to mention the Enbrel, but I would > be remiss if I didn't. Even though you had the low WBCs before, > previously you were on other DMARDs that can cause leukopenia, too > (like > MTX and leflunomide). > > How low were your neutrophils? >> The neutrophil count is not given unless it's called something else. >> The Basophils are 0 (normal 0-1). The eosinophils are slightly high at >> 7 (normal 0-5), and have been above normal at least since last June, >> when they were 10. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2004 Report Share Posted February 15, 2004 Some places call the neutrophils, granulocytes. technically, yes, eos and basos are also granulocytes, but it depends on how the software on the analyzer, or the LIS is programmed. Noreen Re: [ ] or a -Lab Results , Did you not see the part of my message below in green? Could the neutrophils be called something else? The granulocyte % was also slightly low at 39 (normal 43-77) and Absolute Gran, also, at 1.3 (normal 1.4-7.7). One of the articles you sent mentioned radiation as a cause. I had 35 radiation treatments following a lumpectomy for breast cancer in 2002. At that time, I was taking methotrexate. So maybe that had an impact. I'll remind the rheumy of that. The radiation oncologist told me that I couldn't take mtx during radiation, but when the rheumy didn't give me an alternative medication, he said I could keep on taking it. This might have been a mistake, but otherwise I could have died from pain. <grin> Thanks so much for your help. Sue On Saturday, February 14, 2004, at 05:10 PM, wrote: > Yes, Sue, I know you didn't want me to mention the Enbrel, but I would > be remiss if I didn't. Even though you had the low WBCs before, > previously you were on other DMARDs that can cause leukopenia, too > (like > MTX and leflunomide). > > How low were your neutrophils? >> The neutrophil count is not given unless it's called something else. >> The Basophils are 0 (normal 0-1). The eosinophils are slightly high at >> 7 (normal 0-5), and have been above normal at least since last June, >> when they were 10. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2004 Report Share Posted February 15, 2004 LOL, Sue!!! No, obviously I didn't see that part. strips away fancy formatting, including color, but it was there in black and white, LOL. I just read the first part and thought that was it. Excuuuuuuuuse me! Depending on the lab, neutrophils can be called " polys, " " segs, " " PMNs, " " bands, " or simply " grans " or " granulocytes " (since they make up the bulk of the granulocytes). There are variations in the way the labs measure and report the white blood cell counts. Even if they don't spell everything out, you can calculate what isn't specified (and some of the values are just approximations). Total white blood cells (WBC) = absolute granulocytes + absolute agranulocytes absolute granulocytes = WBC x (granulocyte %) granulocytes = neutrophils + eosinophils + basophils Since you told me your WBC = 3500, then you can work backwards and figure the neutrophils in a couple of ways. absolute granulocytes = 3500 x 39% (from the equation above) = 1365 cells At this point, you know your absolute neutrophils can't be over 1365 cells (or you could just look at the absolute granulocyte figure you were given (1.3) and realize, using that figure, that they couldn't be over 1300 cells. If the basophils are at 0% and the eosinophils are 7% of the total number of white blood cells, then the neutrophils are 32% of the total number of white blood cells (since the total granulocyte % is 39). So, absolute neutrophils = 3500 x 32% = 1120 cells per cubic millimeter Again, there may be some discrepancy between the calculations I've done here and your lab results. It depends on how your lab is doing the calculations. Your rheumatologist should be able to answer your questions on this. " White Blood Cell Differential Count " : http://www.labtestsonline.org/understanding/analytes/differential/faq.html " White Blood Cell Count (WBC) and Differential " : http://www.rnceus.com/cbc/cbcwbc.html " Blood Cells and the CBC " : http://web2.iadfw.net/uthman/blood_cells.html I'll tell you where to go! Mayo Clinic in Rochester http://www.mayoclinic.org/rochester s Hopkins Medicine http://www.hopkinsmedicine.org Re: [ ] or a -Lab Results > , Did you not see the part of my message below in green? Could the > neutrophils be called something else? The granulocyte % was also > slightly low at 39 (normal 43-77) and Absolute Gran, also, at 1.3 > (normal 1.4-7.7). > > One of the articles you sent mentioned radiation as a cause. I had 35 > radiation treatments following a lumpectomy for breast cancer in 2002. > At that time, I was taking methotrexate. So maybe that had an impact. > I'll remind the rheumy of that. The radiation oncologist told me that I > couldn't take mtx during radiation, but when the rheumy didn't give me > an alternative medication, he said I could keep on taking it. This > might have been a mistake, but otherwise I could have died from pain. > <grin> > > Thanks so much for your help. Sue > > > On Saturday, February 14, 2004, at 05:10 PM, wrote: > > > Yes, Sue, I know you didn't want me to mention the Enbrel, but I would > > be remiss if I didn't. Even though you had the low WBCs before, > > previously you were on other DMARDs that can cause leukopenia, too > > (like > > MTX and leflunomide). > > > > How low were your neutrophils? > > >> The neutrophil count is not given unless it's called something else. > >> The Basophils are 0 (normal 0-1). The eosinophils are slightly high at > >> 7 (normal 0-5), and have been above normal at least since last June, > >> when they were 10. Quote Link to comment Share on other sites More sharing options...
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