5 replies to this topic

[LivingWellWithCML]

Hi everyone,

I have returned from my 6-week follow-up at Emory Winship and although Dr. Khoury said that I had reached a comfortable CHR and told me to come back in two months for FISH/PCR, I had some questions and a potential concern that I cannot get off my mind - why can't I just listen to the expert and move on?  Ah!  Anyway...

They ran a CBC at Emory today and I've been getting weekly CBCs prior to that at an oncologist's office closer to home - standard procedure for early TKI monitoring.  However, the increase in WBC and neutrophil % this week are making me wonder if test calibration could be that far off, or if I'm starting to normalize in a "normal" range & my marrow decided to kick in with an increased level of normal white cell production over the past week, or if this is a disturbing and unexpected increase.  Here's the data:

WBC // Neut % // ANC

--------------------------------

4/15: 6.3 // 57.2 // 3.6 <-- this was only the third day of Gleevec after ~ 1.5 weeks of Hydro

4/22: 3.2 // 58.5 // 1.9

4/29: 3.1 // 52.40 // 1.6

5/6: 3.6 // 61.40 // 2.2

5/13: 3.3 // 53.20 // 1.8

5/20 @ Emory: 6.0 // 74.0 // ?? (didn't have ANC on the print-out)

The WBC and Neut % are showing a sharp (?) increase after holding steady for the past four weeks - granted, the numbers today (5/20) were from a different facility, and yes - I recognize that both numbers are within the normal range for healthy folks.  It just seemed like a weird increase over the course of only one week.  I did start taking Ciprofloxacin a week ago (and will continue for one more week) because of some prostatitis symptoms - could an antibiotic medication cause an increase like this?

I had all of my numbers on a spreadsheet and showed it to Dr. Khoury, but he was unconcerned and said that I can wait a month before my next CBC.  But I called my close-to-home oncologist and shared this information, and she thought it was interesting to see an increase like that over the course of a week.

Thoughts anyone?

[Happycat]

Dan,

Looking at my handy-dandy Color Atlas of Hematology, the % neutrophils is usually 50-70% of a sample, so your numbers look right within range to me.  I could not tell you what effect the cipro would have on your numbers.

The rate at which your blood counts ramp back up will vary by individual, likely dependent on how many normal stem cells you have and whether or not they are active or still in a quiescent state.  There's some sort of signalling feedback mechanism that tells the stem cells to get busy producing more WBC when they get too low.  (This feedback gets shut off in the leukemic stem cells.)  So id your stem cells have woken up and started producing the WBC, I don't think the rise in your numbers is all that unusual.  If it went over the normal range, then that might be a concern.  But since it is still in the normal range, it's probably just a sign of your hemapoietic system recovering it's normal function.

Traci

P.S.  Totally understand your concern, too.  I will likely be spending time tonight graphing my numbers in Excel, because sometimes I just like to look at the picture!  What an exciting Friday night, eh?  Total geek out....

[Trey]

WBC can change quickly due to a lot of issues, including many benign ones.  I would not be concerned -- just wait to see the next one.

[LivingWellWithCML]

Hi everyone,

Just an update and question regarding labs, since I just had my blood drawn in preparation for a 3-month FISH/PCR.

The CBC info between the oncologist office (which is close to my home) and Emory Winship in Atlanta (which is further and less convenient, but where the CML specialist is) are so very different with respect to WBC ... I find it shocking that the machines are so far off!

The frequent CBCs that I've been getting this early in treatment have been coming from the onc's office and WBCs are always below normal ... they hover in these ranges:

• WBC = 3.1 - 3.6
  
• ANC =  1.6 - 2.0
  
• Neut % = 52 - 58
  

Meanwhile, when I get my CBCs at Emory Winship, the numbers are way different - but still consistent from visit to visit, like:

• WBC = 6.0 - 6.3
  
• ANC = ~ 4.4
  
• Neut % = 70 - 74
  

I am so baffled that these two labs could generate such different results consistently!

So, which one is right?  I have to think that Dr. Khoury's office at Emory Winship, where they specialize in hematology, must be more accurate.  I like those numbers better anyway, because they are all in the normal range.

Do others who visit different offices for their CBCs see this big of a difference?  Just wondering...

Dan

[CallMeLucky]

You have clear proff that there is variance so at least you can relax a little.  You could bring it up with the Dr's office and see if they have any thoughts.  I found from one facility to another things did vary but not that much.  I agree I like the ones from Emory better, but it is concerning if you are making decisions on the other one and there may be an issue with the way they do things.  You would think they would have caught this before.