Afraid of Low blood counts

Hello everyone - wishing you all a healthy journey/recovery. My Mother has started venetoclax since December, was on calquence previously but had to switch due to atrial fibrillation. Her blood work was in the good average numbers all throughout calquence but have dipped low in most of her cell counts - white blood is at 3.5 (sorry as I don't know the measurements scientific names). So, they are low. I'm afraid, being that she's 81 years old and more susceptible to flu/infections. Is this normal? I'm assuming this is temporary? Is 3.5 too low, like alarmingly low? Thank you all !

[AussieNeil Administrator]

Hi Lee,

You are right to be concerned, but your concern may not be justified! Your Mother's white blood test results include measurements of 5 different white blood cell types healthunlocked.com/cllsuppo...

Per the discussion in that post, there are two of those 5 counts that need to be monitored by your Mother's doctors, the lymphocyte count, (which includes CLL cells) and the neutrophil count. Treatment should drive down the lymphocyte count - that's what we want to see, but it can also cause low neutrophil counts, which per your concern, can mean an increased risk of infection. Provided your Mother's neutrophil count stays above 1.8, her doctors shouldn't be to concerned about her risk of infection. If it drops below 1.8, the dose of venetoclax can be reduced or treatment halted for a while, or injections given (G-CSF into the abdomen skin) to boost the neutrophil count.

The other proviso is how low the lymphocyte count falls and the mix of lymphocytes. As the T lymphocyte count falls, there's an increased risk of viral infections, such as shingles. Is your Mother on an antiviral (aciclovir, famvir, valaciclovir) to protect her from shingles?

Neil

[Hidden in reply to AussieNeil]

Hey Neil, thank you for the quick response! Truly appreciate it! Her neutrophil absolute is 2.10

Lymphocytes absolute is 1.00

Neutrophil value is 61

Platelet is 184 k/ul

RBC is 4.22

The rest of her blood work is perfectly in the middle ranges.

[AussieNeil Administrator in reply to Hidden]

You'll be reassured to know that your Mother is doing very well on treatment. Just check with her specialist about prophylactic antivirus cover in particular.

The neutrophil value is 61 would be in percent, so you should ignore that as it's misleading. Just check the absolute counts for the reason explained here:

healthunlocked.com/cllsuppo...

Neil

[Hidden in reply to AussieNeil]

Thanks again, Neil - bless you! Last question - how long do blood counts stay low before they start to rise again/level out on venetoclax?

[AussieNeil Administrator in reply to Hidden]

How long counts stay low varies with the individual, with several influencing factors. It's usually no more than a few days, but sometimes can stretch out for weeks or much longer. Some people need to have their venetoclax dose reduced for the rest of their treatment.