White Cell Count Levels.

[DustyKat]

Just a question out of curiosity...and probably a dumb one at that! :lol:

Bone marrow suppression, particularly leucopaenia (reduced number of white blood cells); azathioprine should be stopped if the neutrophil count drops below 1.0x10^9/L, the lymphocyte count drops below 0.5x10^9/L or the platelet count below 50x10^9/L.

http://www.dermnetnz.org/treatments/azathioprine.html

So low levels of certain white cells can tell you when you are being too immunosuppressed but are there levels below normal that are an indication that medication is at the right dose? Hell, does that even make sense?

I know you can have thiopurine type tests to gauge response but I am curious if anyone knows if there are studies that have looked at WCC levels and how they indicate response to treatment.

Thanks!

Dusty.

 

[kiny]

Levels of absolute and percentage of every white blood cells should be normal while under medication, I know they are normal for most people. Normal being within the absolute upper and lower bounds for every type of leukocyte, the neutrophils, basophils, monocytes, lymphocytes etc.

Me I have lowered lymphocyte absolute, why they don't know and I am going through tests to find out why, it has nothing to do with medication since even after stopping them they are still at 600 absolute (bounds are 1000-4000 or so), but I am stable at 600 absolute, I am not dropping further which is good. Those lymphocyte absolute counts are what is used to go from an HIV diagnosis to an AIDS diagnosis, although people with AIDS drop below 400 absolute, and then the rate of infections go up dramatically.

The reason for low lymphocyte can be chronic infection. It's especially lymphocyte that should be kept an eye out for because they are the adaptive response of B and T cells, it's rare that someone has lowered absolute neutrophil or basophil etc, which are WBC of the innate immune system.

I think you should be worried if the absolutes are dropping below a certain point, especially if they keep dropping during intervals, but using it as an indication of something working well I just don't think it's possible.

 

[David]

Dusty,

I remember when writing this summary that they talked about a lower WBC actually helping induce and maintain remission. Here's an actual study about that. It's a complicated subject for sure, one I don't understand all that well

Kiny, have them test your vitamin A level.

 

[DustyKat]

@ kiny - I thought it was to be expected that your lymphocyte levels would be reduced, when taking medication, as that is what the Imuran/6mp targets when suppressing the immune system...the proliferation of T & B lymphocytes.

That is what I am eluding to with my question. Matt's blood results consistently return a lymphocyte reading of 0.7/0.8. So does having a lower lymphocyte count equate to a better response to treatment than say those whose lymphocyte count remains within normal levels.

@ David - Thanks!

Dusty.

 

[kiny]

They might drop a little but they should stay within the normal range. What I don't think is possible is judge if 6mp works by looking at lymphocytes.

They are still figuring out what 6mp and infliximab actually do, you have B and T cell, but you have naive (the ones usually just patrolling the lymph system) and the activated ones, APC activated, they ones actually migrating to the intestine from the lymph nodes en masse. They ones in the intestine are activated lymphocytes. You're not reading the amount of lymphocyte in the intestine when you take a blood reading.

You have also CD4+ and CD8+ T cells, I need to look up which are more prevalent in crohn's disease in the intestine. But again the blood test, at least the normal ones, do not distinguish. (you can get individual counts if you like, I get CD4 and CD8 tested atm)

And any minor cold or infection will throw off the reading too.

Also I think it's too early to just say that those lymphocyte are the main issue. Crohn's disease has frustrated phagocytosis from the APC, that is the macrophages and dendritic cells, they are realsing a lot of cytokine increasing the inflammation, T helpers cells (the CD4+ type), can regulate inflammation, are all lymphocyte in the intestine in crohn's disease actually doing harm, or is it a bacteria activating the APC, or is it the cytokine from the APC causing damage.

What is actually going on with all those white blood cells down there is unknown at this point, but it's really likely to me that they are no all causing issues and most are fulfilling their function as they should.

Well, I'm not much of a help, but I think you're asking if a drop in lymphocyte can be used to determine if it works, and I say no, it is used to make sure the lymphocyte do not drop under the minimum bound. It's a safety measure only afaik.

 

[kiny]

Kiny, have them test your vitamin A level.

will ask for it thank you, I have been at that rate for about a year now, they're going through records to see if I have always had low lymphocyte

not on any medication either that could lower it, the fact I have been stable at 600 for over a year is good, it's still under the lower limit but it means it's nothing worrysome, they found a few bacteria candidate, or maybe I'm someone born with an immnodeficiency

sorry for off topic

 

[Catherine]

Sarah's lymphocyte have been sitting on 0.9, which was main reason her gi didn't want to increase aza without the blood test. I looked back at previous results and found that started in drop at the same as hemoglobin prior to dx

her lymphocyte are now in normal range and so is her hemoglobin.

 

[hawkeye]

I had to cut back on my dosage as my numbers were 2.3 and 0.4 (not sure what parameters or exponent 10^x). My GI mentioned a "target / preference" of 2.5 and 0.3.

 

[kh216]

This is interesting. I don't have the results of my last bloodwork test, which is taken in March, but I do have the results of my February test. My white blood count level is 3.3, which is too low, but the other components, lymphs, neutrophils, etc. are normal. I am on 6mp. Doctor lowered my dosage after the February test.

 

[Samboi]

I have neutropenia - which the haemo presumes was caused my long term sulfasalazine use (about a decade).
Neutrophils are the WBCs that fight infections.
Even with a zero neutrophil count (no immune system!!) I still had flaring.
I take neupogen three times weekly to boost my WBC.
In lower doses - it actually caused me to have mild flares and generated considerable bone pain. In a higher dose - the flares are not present and bone pain has diminished significantly.

These days I take Humira to supress my immune system.
Neupogen to boost it.
It has literally taken years to get the medications balanced right to work - this has finally come in to fruition in the past three months.
My niggly colds have gone and no more staph infections.
And no more mouth ulcers - best of all!!