Please help me

[abhay]

MY Father aged about 68 years is suffering from Aplastic anemia. He is treated with Cyclosporine 125 mg twice a day from 02.12.11. On 20.12.11 a blood test is done report were Hemoglobin 8.4, WBC(Neturophill 35, Lymphocytes 63, Monocytes 1, Esnophill 1) 4200 and platelet counts 55000. Again on 27.12.11 a blood test was done results are Hemoglobin 7.3, WBC 3200(Lmnphocytes 60, Neutrophill- 35, Monocytes 1, Esnophill 4) Platelet counts 52000. Before the cyclosposrine started his platlet counts use to vary in between 10,000 to 15,000 and every week platlets need to be transfused and it sed to get low around 8000. My question is Is my father is responding to the treatment if yes, then why the platelets counts and Hobgoblin has decrease in one week.

Regards

Abhay

[Neil Cuadra]

Abhay,

I don't think that a single CBC (complete blood count) test gives you enough evidence to draw conclusions about the cyclosporine because blood counts can vary up and down from day to day. If your father's HGB and platelets continue to drop over his next few blood tests then the doctors may be concerned, but if his counts go up one week and down the next week that's not unusual.

Going from platelets of 10,000 to 15,000 up to 52,000 to 55,000 is a big improvement. It's still low, since a normal platelet count for a healthy person would be at least 150,000, but it puts him in much less danger and I think the platelet increase is a good sign that the cyclosporine is helping your father.

Your father's white count results show that he had an absolute neutrophil count (ANC) of 1470 on December 20 and an ANC of 1120 on December 27. Both 1120 and 1470 fall into the range called "mild neutropenia", which is slightly below what some treatment centers consider normal, but not a cause for panic. I used the ANC Calculator to compute those numbers.

You didn't say what your father's HGB was before he started cyclosporine. Was it much lower? The difference between 12.4 and 14.9 may reflect only week-to-week fluctuations and not a downward trend. You'll know more from the next few CBCs. The normal HGB range for men is about 14 to 18 but for older men it's usually lower, in the 12 to 15 range. That means that your father's HGB is about 40% to 50% below normal. Perhaps it will improve further if the cyclosporine is given more time to work.

Good luck!

[abhay]

Dear Neil,
Thank you very much for reply.

Please find below the detailed blood report of my father.

Date Haemoglobin WBC Count Platlet Count
18.11.11 8.8 2200 19000
19.11.11 7.1 1600 11000
20.11.11 7.5 9000
21.11.11 7.4 1900 17000
22.11.11 7.0 2200 7000
23.11.11 7.3 2300 9000
24.11.11 ---------- ---------- 10000
25.11.11 6.3 2300
29.11.11 7.8 3100 15000
02.12.11 7.3 3500 11000
06.12.11 7.4 4400 8000
14.12.11 7.4 5500 50,000
21.12.11 8.4 4200 55000
27.11.12 7.3 3200 52000
Please note that on 26.11.11 he was transfused with 1 unit blood and 2 unit platlets and again on 07.12.11 one unit of blood and two units of platlets are transfussed after till date no blood or platlet has been transfused. Daily 250 mg of cyclosporine tablets and 2.5mf of folic acid tablet is given to him.
I want to know that it seems that cyclosporine tablets are working. The cyclosporine tablets has been started from 02.12.11

Waiting for your reply

Regards

Abhay

[Neil Cuadra]

Abhay,

It's good that you are tracking your father's blood counts and transfusion records.

Your father's HGB and WBC have fluctuated but are slightly higher than before he started cyclosporine. There was a significant platelet increase. But you can't tell if those changes were due to the cyclosporine or the transfusion on 07.12. You'll have to wait longer to see the longer-term trend.

Perhaps the cyclosporine is helping, but you can't be sure. So far it's not enough to bring his counts up to normal levels, but the doctor may consider them to be good enough for now. You might ask how low the doctor thinks your father's HGB and platelets can go before he should be given transfusions.

For the bigger picture you might also ask his doctor if there are other treatment choices and how to decide among them. In the U.S. they often use ATG in combination with cyclosporine, or try to boost blood counts with growth factors. I'm not familiar with the typical treatments in India. Remember that most Marrowforums users, including me, are caregivers or patients, not medical experts, and what we've learned comes from our own experiences.

By the way, the last blood counts you posted above say "27.11.12". Did you mean 27.12.11?

[abhay]

Dear Neil,

Thanks for the reply , here in India for the aplastic anemia the treatment is ATG with cyclosporine, but in father's case the doctor says that it is risky for going with ATG as the ATG lower down the immunive system of body and there are chances of severe infection, so first they will try with cylosporine and if it fails then only they will go for ATG with cyclosporine.
As the last blood tranfusion was on 07.12.11 and normally the platlets life are 4 to 5 days only. so it seems that cyclosporine is working. However the response time id minimum 4 to 8 weeks for cyclopsorine. So let us pray for the best.
Again tommorrow a blood test will be done and I will send you the report.
The next appointment with the Haematlogist is on 17.01.12.
The last blood test was done on 07.12.11

Regards

Abhay

Originally Posted by Neil Cuadra

Abhay,

It's good that you are tracking your father's blood counts and transfusion records.

Your father's HGB and WBC have fluctuated but are slightly higher than before he started cyclosporine. There was a significant platelet increase. But you can't tell if those changes were due to the cyclosporine or the transfusion on 07.12. You'll have to wait longer to see the longer-term trend.

Perhaps the cyclosporine is helping, but you can't be sure. So far it's not enough to bring his counts up to normal levels, but the doctor may consider them to be good enough for now. You might ask how low the doctor thinks your father's HGB and platelets can go before he should be given transfusions.

For the bigger picture you might also ask his doctor if there are other treatment choices and how to decide among them. In the U.S. they often use ATG in combination with cyclosporine, or try to boost blood counts with growth factors. I'm not familiar with the typical treatments in India. Remember that most Marrowforums users, including me, are caregivers or patients, not medical experts, and what we've learned comes from our own experiences.

By the way, the last blood counts you posted above say "27.11.12". Did you mean 27.12.11?

[Hopeful]

Hi Abhay,

You really need to look at trends month-to-month and not day-to-day or even week-to-week. Hopefully, your father will have a positive response to the cyclosporine. Be patient, as it takes time for the marrow to heal, and you will see fluctuations along the way.

[abhay]

Dear Neil / Hopeful

As stated you earlier yesterday blood test report of my Father has come it is as follows.

1) Haemogloin- 6.2
2)WBC 3700(Neutrophill -60, Lymphoctyes- 35, Monocytes- 1,Esnophill- 1)
3)Platlet Counts- 42000.

Except WBC both are decreasing from the last two week. As the Haemoglobin level is low today we will transfuse blood.
GOd onlys knows what is happening

Regards

Abhay