If you're willing, I'd very much appreciate your advice on/reactions to the results of my blood counts. As you'll see above, 1) my hematocrit is low at 36.7%, well below the goal of 42%, 2) my white blood count is 4.2, below the goal of 10.0, and 3) and my platelets are at 218, below the ceiling of 400. My red blood count is low at 3.
My doctor tells me these counts look very good, though it appears to me that I might be anemic with such low red blood counts. Moreover, I am beginning the process of switching from hydroxyurea to Besremi, because I'm hopeful this switch will potentially allow me to benefit from the disease-modifying impacts of the interferon.
Should I expect these counts to change on Besremi? Should my red blood cell counts increase with the change of medication? What should I be looking for as I make this transition?
Thank you for any reactions or advice. I'm grateful for this community.
Written by
SouthSideA
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You appear to be on the edge of anemia based on your HCT and HGB. RBCs are a bit lower than is ideal; however, I do not think the doctor would consider you anemic. Any lower and you would be. Based on the leukocytes and platelets, if you were staying on HU then a dose reduction would be an appropriate consideration. Note that the high MCV and MCH indicate macrocytosis which is expected with HU. The primary issue is how you feel rather than the numbers in and of themselves.
You should expect these numbers to change when you transition to Besremi. It will take some time and trial to find your optimal dose. This is expected and you should be monitored on a regular basis to track your response. Many docs follow the every two weeks protocol until hematologic stability is reached. How the numbers will change will be based on how the transition is managed. The rate of titrating off HU and titrating up the Besremi will cause the numbers to change. The doc will likely try to keep you within the desired goal range but the numbers may flex a bit. That is to be expected and is OK.
Your doc will also be monitoring liver and kidney function. You should expect regular CMPs along with the CBCs. This is a standard practice. It is not unusual to see elevation in the Liver Function Tests. A mild elevation is nothing to worry about. The label indication is to modify dose if the elevation is 5X/Upper Limit of Normal or if there is LFT elevation plus elevation in bilirubin. I experienced an elevation in LFTs to 3X/ULN. My Integrative Medicine doc recommended a milk thistle extract supplement, which returned LFTs to normal.
It sounds like you have a well thought out plan. The focus on the potential for disease modification is one of the reasons many of us choose Besremi. I would also note that I found Besremi more effective and easier to tolerate than HU. I have been very pleased with my response to Besremi, including reducing VAF from 38% yo 10%.
Wishing you success on the next stage in your journey.
There is a Ratio between 150 to 450, you are fine , no need to worry.
Mine were really high in the 700s so I brought mine down with Alternative Medicine Cayenne Pepper, sprinkling it on everything lol...it worked too...went down to 242, never have a Heart Attack with Cayenne, I carry it with me all the time.
your whites are fine, the goal isn’t ten , it’s less than 10. Your reds etc are a bit low , a twinge less HU should correct that. Trying Bes could be beneficial in the long term assuming no tolerance/sides issues, your doc should advise on how to transition, if I was changing meds I would prefer to do weekly or fortnightly blood tests to keep an eye on counts., your doc should know that.
I don’t have anything to add beyond what’s been stated, and Hunter’s response is right on. It will take a number of months to sort things out with the change to Besremi. I hope you tolerate it well and that it can get about its business of disease modification!
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Falling red blood count.
A follow up to my post about switching from hydroxyurea to interferon. Questions about switching to besremi or anagrelide.
Besremi and Rux Combined
Besremi Update 15 Months 
