Counts falling after ATG

[solitarymusic]

Hi Everyone,

I'm new to this forum, but have been reading all the posts here since I was diagnosed in early June 2014.

I had my 4-day ATG treatment in early July 2014, and was discharged from the hospital after about a fortnight's stay, and I see my doctor every week to monitor my counts.

My numbers upon discharge are as follows: WBC 1.2, ANC 0.39, HGB 8.3, Plt 14

I was put on some medication to prevent serum sickness (Prednisolone etc). Within a week, my WBC saw a stellar recovery: WBC 4.35, ANC 2.00, HGB 7.4, Plt 6.

I had a bag of platelets after that, but otherwise it seemed like good news.

However over the next couple of weeks, after my steroids were tapered off, I'm seeing falling counts again every week, and my HGB even hit the lowest point they have ever been. Currently they stand at WBC 3.75, ANC 0.60, HGB 5.8, Plt 11.

I'm really afraid that the ATG treatment isn't working. The doctor says she'll give it 6 months before she declares it a failure, but is there anyone here who has seem falling counts even after the ATG treatment? Isn't the ATG treatment supposed show even minimal growths across some lines?

Will appreciate any advice, as this is a condition that I can't seem to actively do anything about... Thank you all

[curlygirl]

It's the prednisone. My son's WBCs went from 2.2 up to 7.2 on prednisone and when he tapered off they went back down to 2.2 again. You would almost never see a response so soon. My son had his ATG in early July last year and had his last blood transfusion in September, so 2.5 months later, which was actually considered really good. So don't worry about the ATG not working yet (impossible, I know!) There is still the same high chance that it will.

[KMac]

Hi Kat,

I am about 30 months post-ATG. You can see my counts both at diagnosis and recently in my signature below.

In concur with CurlyGirl. In my first month after treatment, I experienced an almost identical pattern to what you are seeing with your counts. The Prednisone apparently did the same thing to my white blood count as it did to yours. My ANC went from 0 during treatment to over 600 quite quickly, and then began plummeting again to 100 once the prednisone was removed.

I'd like to mention though, my doctor took it as a good early sign that I had that response to the prednisone. He felt it indicated some reserve of neutrophils in the marrow, which respond to stimulation.

[solitarymusic]

Thank you both for the replies! It's very encouraging to hear that this is normal, and that I'm not experiencing some abnormal massive nosedive. I shall just hunker down and wait for the long haul then.

[Bishbop]

Hi, it's the steroids, I have VSAA and my ANC has always been around 0.05 when I was on the steroids post ATG it's went up to 0.1 not high but high for me! And my white blood count went up to 1.2, a few weeks later my WBC was back down to 0.65 and my ANC was back down to 0.02, it's very disheartening as you think it's a sign,I'm still waiting my for some change, the last 3 weeks my ANC has gone from 0.03, 0.04 and 0.06 and my WBC has changed to 0.83, 0.85, 0.87 so who knows maybe it's a sign

Hope your counts are improving xxx

[Cheryl C]

Can topical cortisone cream used for dermatitis also raise counts? Last month my neuts were 1.2 which is more than twice what they normally are.

[solitarymusic]

Hi everyone!

Thank you for being kind enough to respond to this. It certainly meant a lot when it looked like my body wasn't responding to the treatment.

Just an update, 6 weeks after ATG treatment, my body seems to have started responding. At my last doctor's appointment, my bloodcounts have gone up to: WBC 3.25, ANC 1.27, HGB 8.4, Plt 67.

I haven't had a platelet transfusion in over a month, and it looks like I won't be needing anymore, if my platelets keep going up! My neuts also look like they're on the upward trend.

Only thing is my red bloods are barely holding it there, and I've had to have 2 bags of transfusion in the past 2 weeks. Do red blood cells take the longest to show improvement?

[KMac]

Hi Kat,

To my layperson's experience, yes the red blood does tend to recover slower. I think this is because our marrow creates all new white cells & platelets every week or so, but the same creation cycle for red blood is about 3-4 months.

I received my last platelet transfusion 7 weeks-post ATG, and my last RBC transfusion about 13 weeks post-ATG.

Do you know how your reticulocyte count is doing? I believe rule of thumb is they like to see it over 60,000 to indicate the marrow is responding sufficiently to the anemia. However, in my case it didn't surpass that until just this month, 29 months post-ATG, yet somehow I got my Hgb up from 5.8 to 14.4 in the meantime anyway. My retics generally bounce around between 20,000 and 60,000. At diagnosis, my retic count was 0. My body had completely stopped making red blood, at least for statistical purposes (they found a few cells here and there, and I suppose from those last bits of functioning marrow, hematapoiesis was reconstituted & my life was saved & health restored post-ATG).