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WBC and blood differentials...

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Posted 7/30/2014 5:19 AM (GMT 0)
Does anyone who is post transplant have a low WBC? Also, I noticed that at times, there are "high results and low results" specifically with the "blood differentials" (neutrophils, mono, lymph, band, Beta, ABS Mono, ABS Lymph)? What is the reason for this? Is this due to a potential virus or potential infection? Or, is this because of the immunosuppression medications (prograf)?
I hope I am explaining my question correctly :-)
Thank you,
WD
Posted 7/30/2014 7:37 AM (GMT 0)
Hey WD! It is not uncommon to have a decreased WBC post-transplant. It's actually a side effect of both CellCept and Prograf. It's one of the reasons why the recipient is more prone to infections. If the transplant team feels that the count is dipping too low, a tinkering of meds is usually done (if other causes of the decrease are ruled out, of course).

As for the neutrophils, lymphocytes, monocytes, basophils, eosinophils (these are all white blood cells) - they can vary a bit up and down, and usually it is not an issue. The differentials can be helpful in diagnosing infections, inflammation, autoimmune disorders, etc. As with other labs, they also keep their eyes open for any trends. The neutrophil/lymphocyte ratio can be important, as it can be an indicator of a recurrence of HCC post-transplant.

I don't know if that helped any, but I'm half-asleep and it's all I could think of at the moment! Lol

Post Edited (Splashdancer) : 7/30/2014 1:58:17 AM (GMT-6)

Posted 7/30/2014 10:56 AM (GMT 0)
Hi Splashdancer,
Thank you for the information. Can you give me more details regarding the neutrophil/lymphocyte ratio indicative of reoccurring HCC?
Thanks again.
Posted 7/31/2014 11:27 PM (GMT 0)
From what I can remember, if the neutrophil/lymphocyte ratio is elevated prior to transplant, there is an increase in the chances of HCC recurring post-transplant. As for how much of an elevation they look for, I'm not sure - I would have to look it up. Some information is harder to remember than others, especially when it's something hard to understand in the first place - and I had a tough time understanding the whole neutrophils, lymphocytes, eosinophils, blah-blahcytes, and who-villephils the first time around! Lol
Posted 8/1/2014 12:32 AM (GMT 0)
It's kind of a crude systemic inflammation marker that's useful with certain forms of cancer, HCC being one of them. Typical normal people will run around 1.5 to 2.0 or so. But when it gets up above 3 then things are noted, and levels of 5,6 or even 7 are possible will cancer recurrence being very likely. It's something I keep my eye on as well as my CA19-9, CAE & AFP levels too.
Posted 8/1/2014 2:27 AM (GMT 0)
I spoke with both the hepatologist and nurse practitioner and they both told me it's nothing to worry about. Sometimes when patients are immunosuppressed it's possible to see levels of "highs and lows" with the various blood differentials. It could also indicate that a patient is getting over a virus or a small infection. When a person is immunosuppressed, their bodies react different thus the variation in the blood differentials. At least this is the interpretion that I got when speaking to the doctor and NP.
I didn't ask them about the levels indicating a reoccurance of HCC. I think I will ask them the next time I speak/meet with them. So I can get some clarification and reduce some of the worrying regarding the possibility of HCC reoccurance.

@Splashdancer... Thank you for the information. Are you referring to the Netrophils/lymphocytes ratio PRIOR to transplant regarding reoccurance of HCC? I too have a very difficult time understand the neutrophils, lymphs, Esophils, monocytes, etc. Did Robert also have HCC? I worry so much about the HCC coming back :-(

@bblbt...can you please clarify what you are referring to when you are saying "crude systematic inflammation marker"? What test are you indicating when you said it gets over 3? If you can clarify I would appreciate it... Thanks :-)

Post Edited (Worried daughter2) : 7/31/2014 9:54:52 PM (GMT-6)

Posted 8/1/2014 4:00 AM (GMT 0)
By crude I mean that it's not sensitive nor specific for any particular type of cancer or other endogenous insults. In other words, not much use at all really except for use as a cheap and easy secondary indicator that might add strength to a diagnosis already being flagged by other more sensitive tumor markers.

The number refers to the ratio of neutro/lymph - NLR. My ratio is bouncing around 2.5 to 3.5 and, when combined with my elevated CA19-9, makes me really wonder about the rather large tumor I have in my liver. I still manage to sleep from time-to-time though but I guess you just get used to mental distractions when you have ESLD with all the bells and whistles.

Ratios are generally a great way of looking at things because the fluctuations in both values can get boosted in the overall number which increases the sensitivity. But when the marker has little specificity, it may just serve to drive you crazy. Especially when you also have immunosuppression medications in play as well.

In short WD2, I wouldn't worry about it much. Take care!
Posted 8/1/2014 4:07 AM (GMT 0)
@bblbt ... Thanks for the clarification. I wasn't aware that you had a tumor in ur liver. If you don't mind me asking... Are the doctors concerned? Does it increase your MELD score?
Posted 8/1/2014 4:18 AM (GMT 0)
Yes, Robert had HCC. He had several tumors and two of them needed to be reduced - the directed chemo not only shrunk them, it killed 'em dead!

As for the neutrophil/lymphocyte ratio.....if the ratio is elevated PRIOR to transplant, the chances of an HCC recurrence POST-transplant is increased. The only reason I know about this specifically is because one of Robert's doctors was involved in studies on the subject.
Posted 8/1/2014 4:53 AM (GMT 0)
@ Splashdancer... I am not sure if the specific levels of the neutrophils/lymphocytes were elevated prior to transplant. I will definitely look... I have copies of all my moms blood tests from the last 18 years! Sounds like your doctor took part in an interesting study...was the study ever finalized?
Did the HCC return, post transplant in Robert? Did he have chemo embolization prior to transplant? Sorry to ask so many questions.
Posted 8/1/2014 6:18 AM (GMT 0)
WD2 -

Yes, the doctors are quite worried but we've been trying to find the best solution to move forward with, very tricky. Unfortunately, it's not HCC they're worried about - it's intrahepatic cholangiocarcinoma, the mass-forming type and 6 cm worth. Also unfortunate is that, unlike HCC, you don't get MELD exception points, you get de-listed due to the fact that ICC is notorious in it's recurrence rate.

So, usually you try to do a resection and then wait for several years hoping you've gotten it all and it doesn't come back. Then you can proceed with the liver transplant and everyone's happy. The tricky part here is that my PSC is relentless and isn't planning on slowing down anytime soon (like having a little maniac "partier" inside of me). So a resection will remove the tumor plus a required portion of "healthy" liver along with it, as a margin of safety. This then leaves me with a greatly reduced hepatic reserve to get by on for the required several years free of recurrence. If my liver is to fail during those years, a transplant is not likely to happen.

Like I mentioned, "very complicated, very tricky" as one of my surgeons has put it.
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