HODGKINS LYMPHOMA DISEASE (STAGE IV AES)

HI, NAMASTHE SIR/MADAM

My wife has under gone Chemotherphy (ABVD) 5th cycle on 20.04.15. 6th cycle is proposed on 5th May,2015. Yesterday Blood test was carried out i.e. CBP with ESR, Serum creatinine, serum Bilirubin. 5th cycle was done on 20.04.2015. At that time Blood report i.e. CBP with ESR was carried out. Both dates blood report values are furnished hereunder for your kind perusal and suggestions please.

Blood report values on 2.5.15 Blood report values on 20.4.15

01) Haemoglobin 8.5 Gms (58%) 9.3 Gms. (65%)

02) R.B.C (Total) 3.05 MIL 3.51 MIL

03) A.E.C (Total) ---- -----

04) W.B.C (Total) 5,600 8600

05) DEFERENTIAL COUNT:

A) NEUTROPHILS 73% 79%

B) LYMPHOCYTES 12% 12%

C) EOSINOPHILS 15% 09%

D) MONOCYTES 00 00

E) BASOPHILS 00 00

06) E.S.R ==65==MM/1ST. HR. ==52== MM/1ST. HR

07) P.C.V. ==26.4%== 29.2%

08) PLATELET COUNT 0.99 LACKS 2.37 LACKS

BLOOD PICTURE : NORMOCYTIC/HYPOCROMIC

09) BILIRUBIN (TOTAL) 0.9 Mg/dl 1.2 Mg/dl

10) SERUM CREATININE 0.8 Mg/dl 0.8 Mg/dl

Pegfilgrastim 6mg injection was given to my wife on 21.4.15 to boost up the white blood cells by the doctor. But however the white blood cells was came down to 5600 from 8600 and simultaneously Haemoglobin percentage was also reduced to 58% from 65% as stated above. Kindly let me know the causes for variations in the complete blood picture despite of all the measures taken to boost cell count and also current status of the disease basing on the above CBP report of my wife.

4 Replies

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  • Hi Babu - its really a tough time - pl wait for Doctors guidance

  • Dear Mr. Babu. I can understand your apprehension. From what you mention, the WBC counts seem fine to me. Whether they are 5600 or they are 8500 doesn't make a difference as anything between 4000 to 11000 is considered as normal by most labs. So don't worry about minor fluctuations. As for Hemoglobin, most people experience drop in Hemoglobin during chemo and it takes some more time to correct as compared to WBC. Such drops in WBC and Hemoglobin are different for each and every person and cannot be predicted or explained.

  • It is important to follow absolute counts for the components of the WBC (differential counts), not the percent. They give a much more accurate picture of what is going on. In your wife's case you will be able to follow her neutrophil count. The injections she is getting are specifically for her neutrophil count. For now it is very important to do everything possible to prevent infection if her neutrophils are low. This includes a neutropenic diet. Ask her doctor about it or do a google search for details. Basically it involves very careful food preparation, eating only very well cooked food - no fresh fruits, vegetables, or salads except for a few things with thick skins, and no soft cheeses or yogurt which have active cultures or molds.

    I am copying a post from a lymphoma site which explains how to compute the absolute counts if your wife's labs don't include them.

    5600 x 12/100 = 672 Was 1032 ALC

    5600 x 73/100 = 4088 Was 6794 ANC

    Both numbers have gone down. The treatment, in part, is to lower the WBC/ALC. The lymphocytes often will go below normal and then back up. Her doctor will be monitoring her neutrophils to keep them from going too low, as that would increase her risk for infection. It is not uncommon for them to go below normal during treatment. I don't know how these numbers are reported there. Hopefully one of the doctors can clarify that and the ranges used, as they vary some from one lab to the next.

    Pat

    Copied:

    If you KNOW the percentage of lymphocytes, and the WBC you can calculate the absolute lymphocyte count (ALC) ...

    Basically you are removing the neutrophils from the WBC...

    From my friend Dave Thomas...

    What is the difference between percentage of lymphocytes and absolute lymphocyte count (ALC)?

    Absolute counts are extremely important. If lymphocyte or other counts are reported as percentages of the total white blood count (wbc), the absolute values can be calculated as follows: Total wbc x % cell type reported ÷ 100. This formula can be used for calculating the absolute lymphocyte count, absolute neutrophil count, etc.

    By way of example, if the total white count reported is 25,000 and the percentage of lymphocytes reported is 80%, the calculation is as follows: 25,000 x 80 ÷ 100. The result is an absolute lymphocyte count of 20,000.

    If the total white blood count minus the total lymphocytes is less than 2000, the patient becomes increasingly at risk of infection. This is one of the reasons it is essential to monitor absolute counts, not percentages.

  • Very well explained, Pat! Much better than I could ever do. My knowledge of Lymphomas and leukemias is rather poor. Thanks.

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