WBC reduction goal. Of 6mp

[Dutch941]

Hi all.....
Going to the dr today re 13 year old with severe uc(currently not inflamed)
I'm concerned aBout the WBC reduction....
I know the goal of 6mp is to suppress the WBC....what I can't find ANYWHERE is acceptable limits?....how low is too low??
Does anyone know what the lowest WBC would be before I should start worrying....? We are currently at 2.9
What would ideal be? Is there a levelin which I should be concerned Aout it being not reduced enough?
I would love to have a guideline for what range we sould be in.....plenty of information on net about "normal"range....but I can't find anything about optimal range for a pediatric UC patient on 6mp.....
If Anyone has insight on this please let me know....I would also love any explanation of why a certain level might be preferred or undesired.....
Thanks all!

 

[DustyKat]

Hi Dutch,

I have this protocol for Imuran and IBD from the Western General Hospital in Scotland...

White Cell Count (NRR 4-11). At 2.5-3.5 they recommend halving the dose and at <2.5 discontinuing.

Here is the link...

http://www.ljf.scot.nhs.uk/SharedCareProtocols/SCP/scp/azathioprine%20IBD%20v4.pdf

...the table at the end also includes other blood values that need to monitored and desired levels.

The NHS has various shared care protocols developed by individual health services and they do differ slightly with the values given. Many state that a WBC of <3 is the point at which 6MP or Imuran should be ceased so it is obviously something that each department regards differently.

I haven't seen any differentiation between 6MP and Imuran in regard to the protocols and I don't imagine that age would be a factor either when it comes to a WBC??

Hope that helps,
Dusty. xxx

 

[Dutch941]

Very helpful article! Thanks..I will reference it as a guide today at appt. that article wold suggest a need to reduce, we did, in fact reduce already but only by 10%...thank s again.

 

[Dutch941]

Thanks again dusty...brought it with me and he explained that the real concern is not so much wbc(he is content at 2.9). But more about neutrophils...which are diminished in our case bu not to the point where he is concerned ....

 

[Johnnysmom]

The handout I have says

WBC less than 4,000 but greater than 3,000
During first 4 weeks of treatment- Consider discontinuing drug After first 4 weeks- consider decreasing dose resume initiation of therapy monitoring at every-other-week point
WBC less than 3,000 Discontinue drug/notify physician

When Johnny had this issue his WBC continued to get lower three months in a row after they adjusted his meds. Dr said this was completely normal and it will take several months to correct itself. The lowest was 3.7. The Dr said his neutrophil count was 1.9 so he wasn't concerned. The next month (month 4 after change it was 8.9) Johnny's Dr said the neutrophil count was more important.
The only good news is that a lower WBC is a good prognostic indicator of a longer remission.

 

[Dutch941]

Our neutrophils were at 1.4. But that was a month ago before a reduction in 6 mp of 10%

 

[Catherine]

Sarah's white cell is 4.0 (4.0-11.0). Lymphocytes 0.7 (1.0-4.0) Neutrophils 2.7 (2.0-8.0). GI is going to call back when they decide if any action is required.

They have already decided to repeat Full Blood early next week. In her case the concern is she has cold like symptoms.

 

[niroowns]

Hi Guys,

So your GI doctors don't really care about the lymphocyte count?

 

[Dutch941]

I don't know that lymphocyte count is Not Important...just that my DR watches the neutrophil count closely as that is the indicator that the 6mp is causing too much of a suppressed immune system and that indicates a risk of infection/bone marrow issues...
He pointed out to me that instead of over analyzing WBC..we watch the absolute neutrophil count

 

[Catherine]

Gi is not concerned the wbc level, just how quickly it has dropped. Retesting to confirm level.

 

[littlemissh]

My gastro is also mostly bothered about the neutrophil count rather than wcc or lymph count. My wcc is always low but my aza was only reduced when my neuts dropped less than 1.4. It was only stopped temporarily when my neuts were 0.8.

Studies have shown that even with lymphocyte levels less than 0.5 there is no increase in infections.