neutrophils

[Brigadoo]

Hi everybody,

I have been reading these posts for a while and wonder if anyone has had the same problem. My husband is 76 and been in watch and wait for 11 years during which time he has been really well. 2 years ago he had covid 3 times, lots of infections and ended up on a blue light in hosp with neutropenia sepsis for 4 days. He had intravenous antibiotics and then GCSF injections which unfortunately caused his spleen to enlarge so they stopped the injections as it shot his neutrophils to 8. Anyway he recovered well, has had a couple of infections since but can only have max 4 of GCSF in case his spleen plays up again. This seemed to be working. Last week he got uti and throat infection, was given antibiotics and 4 injections of lower dose GCSF injections which didn’t cause his spleen to swell but this time havnt brought his neutrophils back up from 0.2. Doctors are going to have a meeting about him but wondered if anyone on here had any answers . Thank you so much

Brigadoo

[SofiaDeo]

Has he had his immune globulin levels checked? If they are very low, with his history of increasing infections, immune globulin treatment may be useful to prevent infection in the first place.

[Brigadoo in reply to SofiaDeo]

Erm all new to this, we’ve had it quite easy up till now and just gone along with what his lovely team say. What is immune globulin level and how do we get that checked? Also thank you for replying

[SofiaDeo in reply to Brigadoo]

We have Pinned Posts and other posts on immune globulins you can read about, do a search. If it's been a while since you've read the "CLL basics", a review may be helpful.

Testing is done by asking your docs to test "immune globulins", however it is coded in their systems, they will know what to do. There are several & generally all tested at the same time, at least initially.

[AussieNeil Partner Administrator]

Neutrophils use our blood circulatory system as their means of transport to our tissues, where they protect us from infections, e.g. from cuts and scrapes. Their lifetime in the blood is relatively short - hours to days, depending on how they are measured. If our bone marrow has stopped making neutrophils, when G-CSF injections prompt it to restart production, it takes about 10 days for the new neutrophils to mature and appear in the blood. Otherwise those nearing maturity get a boost and can appear in the blood in a day or so. Hence the neutrophil count blood test is a measure of how well the bone marrow is able to steadily continue producing neutrophils. One of the spleen's functions is to sequester neutrophils for emergency release. When the bone marrow responds too well to G-CSF injections, the excess production of neutrophils gets stored in the spleen, causing it to swell (This is why it's also possible to temporarily increase your neutrophil count by vigorous exercise prior to a blood test.)

An enlarged spleen is one of the listed risks of G-CSF injections, but in 15 years of reading posts to CLL support forums, this is the first time I've ever heard of it happening with someone with CLL. I think that's because we tend to need G-CSF injections when our bone marrow is already highly infiltrated with CLL, so struggles to respond. Your husband's bone marrow obviously has no trouble responding to G-CSF with an increase in his neutrophil count to 8! I suspect the answer from his doctors will be to just more closely monitor your husband's neutrophil count to check that his bone marrow is again working well.

In Australia, immunoglobulin levels are asked by requesting on the blood test form "Immunoglobulin IgA, IgG, IgM"

Neil

[Brigadoo in reply to AussieNeil]

Thank you for your reply. Very interesting .

[Brigadoo in reply to AussieNeil]

What puzzles me is when I read about low neutrophils it usually happens after some sort of treatment, chemo etc. .My husband hasn’t had any treatment at all , just two years ago after having covid 3 times they went down and have never recovered properly unless with the help of gcsf injections. Very puzzling.

[AussieNeil Partner Administrator in reply to Brigadoo]

Many drugs can impact your bone marrow neutrophil production, including NSAIDs. Those three COVID-19 infections could possibly be implicated, given COVID-19 affects more than just the respiratory system. I'd like to see independent verification of this research from Iran, but certainly would explain what's happening.

Bone marrow alterations in COVID-19 infection: The root of hematological problems

sciencedirect.com/science/a...

Irrespective, as CLL bone marrow infiltration increases, bone marrow production has less and less capacity to deal with challenges.

Neil

[Brigadoo in reply to AussieNeil]

Thank you , have just read that, very interesting. When he was in hosp , his consultant did say that it could be as a result of covid but had no conclusions yet .

[Brigadoo in reply to AussieNeil]

Also my husband is always up to date with his jabs. He was given paxlovid first time of covid. To my mind it just suppressed the virus as he got it again a few weeks later. Would never take that again

[AussieNeil Partner Administrator in reply to Brigadoo]

COVID Rebound Can Happen Whether or Not You Take Paxlovid

From the Johns Hopkins Bloomberg School of Public Health.

publichealth.jhu.edu/2024/w...

What initially was referred to as “Paxlovid rebound”—a return of COVID symptoms or test positivity after starting a course of the antiviral—is now more accurately referred to as “COVID rebound,” because rebound can happen regardless of whether someone takes antivirals.

What’s more, it’s likely not a phenomenon unique to COVID, says virologist Andy Pekosz, PhD, a professor in Molecular Microbiology and Immunology. What is unique to COVID is the technology—specifically rapid antigen tests—that allows us to track the progress of an infection so closely.

Researchers are continuing to investigate why some people experience COVID rebound, whether people are contagious during this period, and the role antivirals like Paxlovid might play. But one thing is certain, says Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security who specializes in infectious diseases and pandemic preparedness: The possibility that someone might experience mild rebound symptoms should not deter them from taking Paxlovid if they are at a higher risk for severe illness.

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Neil