Good morning Grace,
My husband started adjuvant chemo (alimta/carbo) 3 weeks ago. At first infusion he was given IV dexamethasone and that next day a neulasta shot. 12 days later, at alimta nadir, WBC were ~3x greater than pre-infusion (6.3, 6.3) vs. nadir at 18.1. At second infusion, WBC was 20.5. The day before he took 2 dexamethasone tablets and the morning of infusion he took one. Today he is supposed to get the neulasta injection.
I have read on Grace that the steroid (dexa) can raise WBC as fast as one day so I think I understand the WBC level pre-infusion #2. But I don't understand the nadir CBC WBC result of 18.1. To combat neulasta pain he is taking claritin for 4 days.
So, my questions are: what can cause elevated WBC at nadir? How high is too high and is neulasta necessary or harmful given the upward trend?
RBCs, Platelets holding steady. Neutrophils (gran) same pattern as WBC (5.3 jumping to 15.8 at nadir and 18.8 at infusion #2)
WBC lab range - 4.0-11.0
Neutrophils (gran) lab range - 1.7 - 8.0
As always, I am deeply indebted to Grace for educating me as well as keeping me somewhat "sane" through this journey.
Thank you in advance,
Lisa
Reply # - March 20, 2014, 07:50 AM
Reply To: High WBC at Alimta Nadir CBC and #2 Infusion – Why and
Hi Lisa,
An elevated white blood count usually indicates an infection of some kind, but Dr. Pinder has also pointed out:
"One must keep in mind that some people have elevated white blood cell counts simply because of the body's general "irritation" about having cancer present." - http://cancergrace.org/forums/index.php?topic=514.msg10533#msg10533
Have you asked your husband's doctors whether they feel the neulasta injection is still required? They are in the best position to determine that, with full access to all of his medical information.
JimC
Forum moderator
Reply # - March 20, 2014, 09:10 AM
Reply To: High WBC at Alimta Nadir CBC and #2 Infusion – Why and
Thank you Janine and Jim for your fast response. Grace and Chaos' veterinarian are almost tied for first place for promptness!
I have a call into onc and hope to hear back before I snatch my husband away from work to get neulasta shot at 1:15 today. Most likely I won't hear and will have to discuss this with nurse when we get to office. I try hard to avoid having these discussions with my husband present because his reactions are usually counterproductive and add to his annoyance that his day is being disrupted. Such are the after effects of 2 TBIs.
Coincidentally, our BC/BS nurse case manager called this AM and I asked her about the WBC. Her advice - talk with onc. But she stated, like Dr. Pinder's comment in Jim's post that ...elevated WBCs due to irritation ... presence of cancer... His WBCs before first infusion were always within normal range. Plus my understanding of my husband's case, is that the pneumonectomy was potentially curative and the chemo is what I call an elective procedure (T2N1M0) so in my crash course caregiver thinking the potential circulating microscopic cancer cells that escaped were too minute to be detected and therefore disruptive to WBC. Don't resist telling me I'm comparing chocolate with vanilla or that I am over-thinking this!
My husband is extremely fatigued and is consistently sleeping late (till 8) in the AMs and till noon last Sunday! He used to be a 5:30 AM no alarm, jump out of bed, got to work, see you at 7PM type. He also has bouts of nausea and vomiting just following infusion for about 2 days. Last night he accused me of making a greasy(?) hamburger for dinner so I realized that he must be feeling nauseated. I have become a mind reader of sorts. Well I convinced him to take a zofran and ate his dinner with gusto!
Thanks again and please feel free to call me out if I have crossed the Grace boundary.
Best wishes,
Lisa
Reply # - March 20, 2014, 12:04 PM
Reply To: High WBC at Alimta Nadir CBC and #2 Infusion – Why and
Update after injection. Nurse explained that neulasta can kick in at time of nadir thus if chemo not impacting blood cells then boost results in elevated. Hmmm. My husband suggested that may be the chemo isn't working which I thought was a clever conclusion sort of in line with my unstated suspicions that chemo might be something else. I hate to bring up conspiracy theories!!!
In the meantime I'll check his temperature over the next few days in case an infection is brewing.
Looking forward to any insight even if it is caregiver critical.
Reply # - March 20, 2014, 08:51 PM
Reply To: High WBC at Alimta Nadir CBC and #2 Infusion – Why and
Yes, Neulasta often leads to a rebound rise in WBC that overshoots normal, but without it, the counts might be quite low. Neulasta typically kicks in about 6-8 days after the injection, so it may well be that counts checked a few days after that are high, but even with Neulasta the counts can be low just before the Neulasta really leads to the effect of raising WBCs. There is no known worrisome effect of overshooting, and we sometimes see WBCs of 20 or 30 or more...it doesn't mean anything other than that the Neulasta is working (overtime, perhaps). It's not the same as having those counts without Neulasta, which would be worrisome for a raging infection or leukemia.
And those numbers have nothing to do with the efficacy of chemotherapy.
-Dr. West
Reply # - March 21, 2014, 05:47 AM
Reply To: High WBC at Alimta Nadir CBC and #2 Infusion – Why and
Thank you Dr. West. Now I can go to the first of 16 master naturalists class I registered for per dx without as WBC angst.
Just wondering how we can bottle your clear, concise, caring and calming communication technique and distribute it to med schools.
All my best to Grace
Lisa