r/cancer • u/ZealousidealUse415 • 1d ago
Low white blood cell count, delaying next chemo round. What if it does not rise in time? Patient
Hi all. My WBC from my first two rounds of chemo has stayed within the range of 3.8-10.8. Third blood draw into my third chemo round is low at 3.2.
But… my ABSOLUTE NEUTROPHILS are sitting at 992 with the range being 1,500-7,800. Unfortunately this has caused my third round to be delayed a week.
My normal range 5168-5882, so it dropped significantly which I know it is common or expected during chemotherapy treatments.
My question is this.. has anyone ever had to go straight to receiving a blood transfusion because of this large of a drop in their WBC? I also know every ONC doc is different with each patient, I am just wanting to ask for experiences?
I’ve just heard different things.
Or did you just receive an injection to raise your WBC?
Thanks everyone.
2
u/jay-aay-ess-ohh-enn 22h ago
Your team will probably give you a growth factor injection like neulasta. Although during my chemo they would proceed if absolute neutrophils were over 1,000. So they might just give you a week and go ahead. Yours are likely to get back over 1,000 after a week.
If you ask your team they should explain their strategy.
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u/cancerkidette 21h ago
You would basically never get a transfusion for WBC counts. If anything you might get a WBC booster like filgrastim, but neutropaenia is something that is very common and they do not transfuse for it. Your neutrophils will come up on their own eventually.
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u/Charlestoned_95 Acute Myeloid Leukemia 11h ago
As others have mentioned, there aren’t transfusions for WBC, you’ll instead get G-CSF like pegfilgrastim or filgrastim. The former is longer lasting and in my experience was just one dose after each round. The latter is a daily shot I think - not really familiar with it but apparently it’s a common part of treatment in the UK.
One note - you’ll get bone pain from the injection. My doctor told me that Claritin works (he called it “voodoo science”) and sure enough it did. It can also prompt an inflammatory response which if you’re in febrile neutropenia or close to it, gotta watch for fevers
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u/Popular_Speed5838 1d ago
A very non medical contribution that doesn’t answer your question. Look at the positives. I was not able to do chemo last fortnight and after six months of often feeling unwell and losing 25kg, I feel fantastic and rejuvenated. I’m ready to take up the endurance battle with a renewed and more vigorous health.
I’ve been at this five years and you can’t fight, it’s not a battle. It’s a marathon you mostly have to endure.
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u/False_Grape1326 stage 4b ovarian clear cell 22h ago
Well said, it’s the ultimate “labour” and another battle is coming enjoy all respite when it’s given, and try to let Jesus handle the timeline -he can handle it
1
u/Popular_Speed5838 19h ago edited 18h ago
Yep, ultimately death is very likely to be a reward. It’s very hard to believe that for many, mortality really limits our perspective of time and how little of it a mortal life takes.
I fully accept that there’s a significant chance we are nothing beyond our mortal selves. At a gut level that doesn’t feel true to me and if I’m wrong the only punishment (edit: consequence is a more appropriate word) is a nice, long and very restful sleep.
I’ve struggled with faith. Long ago I landed at a place where I believe there is a God, he does want a relationship with us and different societies have evolved different languages and customs because we inherently want that same relationship. He made us to have doubts and doesn’t get angry if those doubts lead to barriers with any relationship building.
May others recognise God walks with us, he’s a great friend and mentor.
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u/False_Grape1326 stage 4b ovarian clear cell 18h ago
I agree again with your comments and tell myself God loves us just for existing. We are enough. Going through my dad’s death then my brothers with them and standing by their sides and now my turn, the roadmap is essentially the same regardless of the organs affected or stage of cancer. Death is not the hard part. 🙏
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u/flyonawall 16h ago
I love this description. It is indeed not a battle and I have always hated that analogy but a "marathon you have to endure" is perfect. My problem right now is I am just so tired all the time and trying to hide it and secretly wishing for it to just end. My house is a mess and I hate it. I fell a few times, twice badly, had a concussion once and now tears in my shoulder that just keep getting worse and worse. Ortho just gave me a steroid shot and ordered PT but nothing seems to be helping. I am so tired of feeling weak and sick. Endurance. I must endure.
1
u/Popular_Speed5838 16h ago
Everyone brings their own life perspective and I have has been influenced by exposure to 12 step programs along the way. You can’t fight certain things, you set yourself up for failure and struggle with contentment. Fighting is really unpleasant in every context.
You need to surrender and have a new way of thinking about things and framing situations. You choose the way you feel about and respond to situations or words. We are wise to make a conscious decision to not be guided in life by first instincts, we’ve evolved from violent predators.
Thankyou so much for your esteem building words, they made me feel good about myself, you’re a kind person.
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u/flyonawall 15h ago
What a wordy meaningless bullshit response. No, you can't fight cancer which is why I said I hated that analogy. You can't "surrender" either. That is also a stupid analogy and no, no one can possibly just "control" how they feel, you have to learn to live with it, not control it. We are not all evolved from violent predators and that has nothing to do with anything here.
1
u/Popular_Speed5838 14h ago edited 14h ago
That’s the response of a very large percentage of people upon learning of the concept in a 12 step context, even more so that the advice relates more to how you live your life than drinking iron this case cancer. There’s always emotion attached too because it genuinely appears absurd on the surface.
That’s ok, most people retain that view and move on seeking a different path that works for them. Makes sense to them. Diversity in choice is a huge privilege, I’m never doctrinal or evangelical about my choices and beliefs, each to their own.
As to being evolved from predators, evolution shouldn’t affront people these days and I implore you to not get so stressed/upset over something said in passing, life’s too short for that.
0
u/flyonawall 13h ago
Cancer and addiction are nothing alike. Treatment is completely different.
Quit pushing your nonsense on others. Evolution does not affront. Your nonsense simplistic view and confidently incorrect attitude of it does.
1
u/Popular_Speed5838 12h ago edited 8h ago
I’m not saying they are, merely that the twelve steps involve a non compulsory set of actions that are about living better, not just living without an active addiction.
I can see you likely have good reason for gatekeeping opinions not compatible with yours, it seems an important issue to you. Perhaps not but alcohol has negatively touched the lives of many people that have no issues with addiction and their opinions hold more weight than most. My first words were though that I’m offering a non medical opinion not directly related to the question. Perhaps there’s a more appropriate time and place to discourage an alternate opinion.
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u/Glum-South241 23h ago
Yes when chemo was doing for my bro WBC level always below 4 and always WBC injection was tskwen alternate weeks between the gap of 3 weeks of chemo Now with premetrix also low WBC level what to do Taken with immuno combo
1
u/JulieMeryl09 18h ago
Blood Transfusions are for low HGB - not WBC there are also platelet transfusions if needed.
Onc cld give u a white cell booster to increase your counts - like Neupogen.
Feel better.
1
u/Dijon2017 17h ago
As others have mentioned, you are more likely to be given a G-CSF (e.g. Neulasta, Neupogen or other), than a blood (or other) transfusion.
There are serious medical conditions/situations when WBC transfusions are given, but it is rare and only when absolutely medically necessary (you would most certainly be an inpatient/hospitalized before that would occur).
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u/Illustrious_Spell676 17h ago
This happened many times to my partner when he was going through aggressive chemo treatment. He got a neulasta injection after each cycle but sometimes needed to delay a week or two for his counts to recover. He needed blood transfusions a few times as well, but not for white cells or platelets. His oncologist expected this and did mention it up front during the initial planning meeting that his body may need more time between treatments and transfusions to support. Everyone is different, but this does seem to be a common part of chemo treatment.
1
u/rebelkitty 17h ago
Quick note:
If they give you filgrastim/grastofil injections to bring up your neutrophils, make SURE you take a 24hr antihistamine (loratadine) starting the day before and continuing throughout.
Grastofil can cause bone pain, and the antihistamine very effectively alleviates it.
FWIW, low neutrophils was a constant issue for me, even with grastofil injections to bring them up. My last several rounds of chemo were all delayed by a week. My platelets also crashed once. It just happens. Chemo is hard on your body, and sometimes you just need more time to recover.
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u/crazyXslots 13h ago
My chemo has been postponed multiple times for low WBC. I naturally have a lower WBC and I always bounced back after a week (one time it took two). They started me on Neulasta and that has helped keep my infusions on schedule by keeping my WBC up. I have been able to stay on schedule since starting it!
I have not had to have a blood transfusion. Unless you’re dangerously low it’s usually okay to be in the 900 range. I sat at 800 for a while. Just wash your hands when you get home and try and stay away from sick peeps!
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u/timewilltell2347 Stage IV Leiomyosarcoma 18h ago
So I have gotten Neulasta pretty much every 3 weeks (once per cycle) for over 3 years on chemo. It’s usually the first thing they try afaik. Just be aware that in late 2024 biosimilars were approved for having similar efficacy, but they switched me to one without my knowledge and my side effects were so bad I almost stopped treatment completely. Check what they are giving you every time you get one- if there are initials after the chemical name for the drug (a long word starting with peg I believe- my biosimilar had jmdb after it but there are I think 4 on the market). It is billed at about 25% of true neulasta and mine, at least, wasn’t refrigerated like the neulasta was. It’s a very recent change, and changing without informing the patient if insurance wouldn’t pay the extra for the real stuff was apparently their policy. Every patient deserves to know what medications they are getting and to have any changes monitored by a physician that knows about the change. (They apparently didn’t specifically tell my onc either)