when should i get worried about my CBC ?
 

Hi, brand new to this forum. I am hoping to get someone to review my last CBC. Here are the values. I have been on chemotherapy for the past six years. My doctor supports me continuing but says at some point my body is going to "reject" the drugs. Below, the MCH has always been slightly high, and the MCV has been slightly high and that my neutrophil count is usually low....other than small derivations from this list, these tests are pretty representative of my normal. How close am I to needing procrit/aranesp or neutrophil shots?

And how long can I go before having to stop this? Before having to get my bone marrow replaced?

As mentioned I have been on this chemotherapy regiment for six years. Thank you.

Hemoglobin 13.7 - 17.3 g/dL 13.6
Hematocrit 0.39 - 0.49 L/L 0.39
RBC 4.37 - 5.74 X10^ 12 3.54
MCH 26.5 - 34.0 pg 38.4
MCHC 31.5 - 36.3 % 35.2
RDW-CV 11.5 - 14.5 % 13.9
MCV 80 - 98 fL 109
Nucleated RBC % 0.0
Nucleated RBC Count 0.00 - 0.00 X10^ 9 0.00
Platelet Count /L 150 - 450 X10^ 9 206
WBC 3.2 - 9.8 X10^ 9 4.6
Neutrophil % 37.0 - 80.0 % 44.9
Lymphocyte % 10.0 - 50.0 % 34.8
Monocyte % 0.0 - 12.0 % 16.0
Eosinophil % 0.0 - 7.0 % 3.9
Basophil% 0.0 - 2.0 % 0.4
Neutrophil Count 2.0 - 8.6 X10^ 9 2.1
Lymphocyte Count 0.6 - 4.2 X10^ 9 1.6
Monocyte Count 0.0 - 0.9 X10^ 9 0.7
Eosinophil Count 0.00 - 0.70 X10^ 9 0.18
Basophil Count 0.00 - 0.20 X10^ 9 0.02

When to worry?
 

Those counts look fantastic to me. By comparison, My WBC is 1.5, platelets 73K, neutrophils .3 and hgb 9.8. No treatment yet

thanks for your reply revchris. When/if the time comes, what options are out there for bone marrow transplant? The thought and sound of it scares the ___ out of me. I have heard of something new where they don't have to actually "drill" into your bone to extract healthy marrow. That they can give you a shot or something less invasive. Can't remember where and when I saw it, but something about it not being FDA approved here in the US but that they are using it in Europe?

Are you male or female?. The ranges differ. Procrit, aranesp those are used to boost your hemoglobin, yours looks good near 14. Your platelets are at the low end of normal but in range, good. Your WBC is a bit low but not by much.

You are asking about a Bone marrow biopsy?, not many docs use a drill, they use some special needle. Its scary but you'll get different responses some have it not so bad and some get knocked out for it. Mine wasn't that bad compared to what some go through. No ones going to know your transplant options or if youll ever need one, lets hope not. There's plenty of great info on here.
Your Doc doesn't know when it will stop working so lets hope 6 years from now its still working and he tells you the same thing.
All the best!

This may be about the two methods used to collect stem cells from bone marrow donors. In other words, it's about the donor's experience, not what happens to the transplant patient.

In a traditional bone marrow donation, the donor receives an anesthetic and bone marrow is extracted from their hip in a surgical procedure. It's very much like the bone marrow biopsy procedure that patients undergo for diagnostic reasons. My wife's bone marrow donor had this procedure and said she was sore for a couple of days but nothing she couldn't tolerate.

The newer technique is stem cell donation, in which the donor is given shots of Neupogen to move some of their stem cells from their bone marrow into their circulating blood. The stem cell donation is then just like a regular blood donation, no surgery involved.

In either case, the patient having the transplant gets the marrow/stem cells through an IV, just like a blood transfusion.

thanks for the reply sbk007. I'm am blazing new ground with the chemo combo I am on. In reading about the MCV, the red blood cells that I am producing are too large which is causing anemia. But, I have not had any major problems yet. My fear is that I will need a bone marrow transplant; in fact my doctor said so much. However, she supports me while on this regiment, but only under close monitoring. If things start to go south, and my doc, folks on this board and myself agree that I am a ways out from this, my fear is that my bone marrow will be too damaged to produce normal blood cells. If I need the needle, I have seen this done and it looks beyond pain that I could endure, awake anyways. How is the process performed? Do they grab stem cells from within an undamaged area and inject into an area of large growth? Do you need a donor match? How have other folks on this board done it? What are my range of options? Thank you sbk007 and all for feedback of any kind.

Neil, that IV method is what I was thinking about. Is this approved in the US? Which hospitals or facilities are doing it? Thank you !

I think it's used everywhere in the U.S. now. The decision about which to use is based on patient needs and donor preferences.

All those questions are better answered by doing a search for stem cell transplants from your favorite search engine, there is a lot of info outlining the whole procedure much better then most of us could post. Give it a try.

stem cell transplant
 

The stem cell transplant is the preferred method these days. I doubt that it would not be allowed for your disease. Bone marrow/Stem cell transplant is the only cure. Chemo is just about maintenance.

Before receiving the bone marrow or stem cells, you have high dose chemotherapy and possible total body irradiation depending on the recommended regimen for your disease. After the nadir is past, then the stem cells are infused and you are supported by antibiotics and blood products until your new bone marrow takes hold. It's truly a miraculous thing to see patients emerge from their room when their counts start to come back.

It's been a while since I've worked on the BMT unit, but that was the general procedure then.

BBB,
I have some similar results (but am not on chemotherapy). My docs are concerned about the ongoing (1.5ys) neutropenia but have not been concerned by the borderline low/low RBC with consistently elevated MCV (~100-102). I read that one important way of looking at it was to have reticulocytes measured (my docs have only done this twice, and the recent time was because I asked!), and to calculate the "Reticulocyte Production Index: caluclation to determine whether bone marrow is producing an appropriate response", which should be 1-2%. Ie, if RBC are low, retic count should be up. My RBC are low, my reticulocyte count (absolute) was low, and the RPI was low (in my understanding of it)!). So .4% reticulocytes, 14960 absolute retics; and .33 RPI. But because my hgb was wnl, docs aren't concerned. I've wondered if my blood cells compensate for fewer RBC by making them larger? I don't know what it all means, sorry!

My rheum's choice of drug for me is a low-dose chemo agent, but she's witholding that until we rule out any bone marrow trouble. The med could theoretically help suppress an autoimmune cause to my blood cell problem, resulting in an increase in blood cells. But of course, it could horribly go wrong, inhibiting bone marrow production even further. I've a hit a wall where there is nowhere to go right now in treating me.

Good luck!