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Result: The result column shows counts that fall within the normal range. Flag: The flag column shows counts that are lower ("L") or higher ("H") than the normal range. Reference Interval (or Reference Range column: The reference interval shows the normal range for each measurement for the lab performing the test. Different labs may use different reference intervals. White blood cells: White blood cells help protect individuals from infections. The above CBC report shows that the patient’s total white cell count is 1.5, which is lower than the normal range of 4.0-10.5. The low white cell count increases the risk of infection. Differential: This portion of the CBC shows the counts for the 5 main kinds of white cells, either as percentages (the first 5 counts), or as the absolute number of cells (the second 5 counts). Absolute neutrophil count: Neutrophils are the main white blood cell for fighting or preventing bacterial or fungal infections. In the CBC report, neutrophils may be referred to as polymorphonuclear cells (polys) or neutrophils. The absolute neutrophil count (ANC) is a measure of the total number of neutrophils present in the blood. When the ANC is less than 1,000, the risk of infection increases. The ANC can be calculated by multiplying the total WBC by the percent of polymorphonuclear cells. For example, this patient's ANC is 0.34, which equals the white blood cell count (1.5) times 23%. Red blood cells: Red blood cells carry oxygen from the lungs to the rest of the body. The above CBC report indicates that the patient has a red cell count of 3.5, which is lower than the normal range of 4.70-6.10, and therefore, shown in the flag column. Hemoglobin (Hb or Hgb): Hemoglobin is the part of the red cell that carries the oxygen. The above CBC report indicates that the patient's Hb count is 10.8, which is below the normal range of 14.0-18.0. The hematocrit (HCT), another way of measuring the amount of Hb, is also low. This means that the patient has mild anemia and may be starting to notice symptoms. These three ranges will vary depending on age and gender. For women, they will be lower than those shown here. For example, the Hb reference interval for a woman is 12.0-16.0. Platelets: Platelets are the cells that form blood clots that stop bleeding. The above CBC report indicates that the platelet count for this patient is normal. Can neutropenia be prevented?Chemotherapy-induced neutropenia can be prevented in most patients with the use of Neulasta® or Neupogen®, blood cell growth factors that increase your white blood cell production. Blood cell growth factors are naturally occurring substances called cytokines that regulate certain critical functions in the body. They are responsible for stimulating your cells in the bone marrow to produce more white blood cells. Chemotherapy drugs destroy many of the normal, rapidly dividing cells in the bone marrow, thereby reducing white blood cell production. With today’s technology, two blood cell growth factors, Neulasta® and Neupogen®, are manufactured in large quantities and can be administered to help the recovery of your bone marrow white blood cell production. Prior to the development of blood cell growth factors, neutropenia commonly prevented patients from receiving their chemotherapy treatment at the full dose according to the treatment schedule. Moreover, bacterial and fungal infections, as well as fatalities from these infections were more frequent. Doctors have long known that, in certain malignancies, the administration of more chemotherapy kills more cancer cells, resulting in more patients being cured of their cancer. However, neutropenia has long prevented doctors from giving full-dose chemotherapy treatment. What treatments are administered to prevent neutropenia?The blood cell growth factors approved by the Food and Drug Administration for the prevention of chemotherapy-induced neutropenia are Neupogen® (filgrastim) and Neulasta® (pegfilgrastim). Neupogen® has been extensively studied and used for the treatment of chemotherapy-induced neutropenia since 1991. Neulasta® was approved by the FDA in 2002. Neulasta® helps the bone marrow create more neutrophils, which are crucial to the body’s ability to fight infection. With acceptable neutrophil counts, patients are also more likely to stay on their chemotherapy schedule as originally planned. Multiple clinical trials have shown that Neulasta® and Neupogen® reduce the severity and duration of neutropenia associated with many kinds of chemotherapy regimens. By reducing the duration and severity of neutropenia, Neupogen® has been shown to decrease a patient’s risk of fever and admission to the hospital for treatment of neutropenic fever. The drawback of Neupogen®, however, is that it must be administered daily. In an effort to address the daily dose requirements of Neupogen®, researchers developed Neulasta®. Neulasta® may be administered as a single dose for each chemotherapy cycle. In two clinical trials, a single dose of Neulasta® has been proven to be as effective as an average of 11 daily injections of Neupogen® for the management of neutropenia.[1][2] The most common side effect you may experience with Neulasta® is aching in the bones and muscles. If this happens, it can usually be relieved with a non-aspirin pain reliever, such as acetaminophen. It is also possible to have an allergic reaction to Neulasta®. Use of Neupogen® and Neulasta® has also been shown to increase the likelihood that patients will receive their chemotherapy according to the treatment plan. Neulasta® is generally well tolerated, with minimal side effects. Approximately 1 of 4 patients treated will experience some mild aching or discomfort in their bones. Symptoms persist only while being used and can typically be treated with non-narcotic analgesic medicines. To learn more or to read about the results of specific clinical trials evaluating Neulasta® for the treatment of chemotherapy-induced neutropenia, go to www.neulasta.com. Given the option, most patients would prefer to take steps to help protect themselves against infection caused by neutropenia, rather than deal with the problems cause by an infection after it develops. However, on average, fewer than 10% of patient receive protection from infection at the beginning of their chemotherapy.[3] Yet up to half of patients receiving chemotherapy develop dangerously low white blood cell counts, potentially placing them at risk of life-threatening infections.[4] That’s why patients should ask their doctor about treatment with an approved blood cell growth factor. What are the Strategies to Improve Treatment?The reduction in the frequency and severity of neutropenia and its associated complications has resulted from scientists developing a better understanding of the basic biology of bone marrow blood cell production and from participation in clinical trials designed to evaluate strategies directed at reducing neutropenia and its complications. Currently, there are several areas of active investigation aimed at improving the prevention and management of neutropenia. Peripheral blood stem cells: Stem cells responsible for the production of neutrophils can be collected in large quantities from the peripheral blood. Delivery of peripheral blood stem cells following very high doses of chemotherapy has been demonstrated to result in more rapid neutrophil recovery than with stem cells collected from bone marrow. Many doctors have begun evaluating the use of peripheral blood stem cells to support multiple cycles of dose intensive chemotherapy alone or in combination with Neulasta® or other blood cell growth factors for the purpose of reducing the frequency and severity of neutropenia and its complications. Ex vivoexpansion: Stem cells responsible for the development of neutrophils can be removed from a patient's body and grown or expanded in the laboratory. When large numbers of neutrophils have been grown in the laboratory, they can be infused into a patient to support delivery of chemotherapy with the goal of preventing neutropenia. The process of ex vivo expansion is currently being evaluated in clinical trials at some centers around the country. References [1] Vose J, Crump M, Lazarus H. Randomized, multicenter, open-label study of pegfilgrastim compared with daily filgrastim after chemotherapy for lymphoma. Journal of Clinical Oncology. 2003;21: 514-519. [2] Green M, Koelbl H, Baselga J. A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Annals of Oncology. 2003:14:29-35. [3] ADVANCE: Awareness of neutropenia in chemotherapy. 2001;1:3-4.7. [4] Adams, VR. Adverse events associated with chemotherapy for common cancers. Pharmacother. 2000;20(7 pt 2):96S-103S. home | about us | your visit | cancer info | treatment | testing | clinical trials | patient support | site map | |
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