Mariners' Queries

What blood counts should we track?

KH: An individual who has been diagnosed with CML should have routine blood tests, including a Complete Blood Count (CBC), blood differential and liver function tests (LFTs), done on a regular basis to help monitor treatment response.  The following counts are important to determine one's clinical status:

COMPLETE BLOOD COUNT AND
DIFFERENTIAL:
A Complete Blood Count (CBC) that measures the number of white blood cells (WBCs), red blood cells and platelets in the patient's sample of blood should be routinely monitored in CML patients.  There are actually five kinds of white blood cells, each with a different function.  The five types of white blood cells are monocytes, lymphocytes, basophils, eosinophils and neutrophils.  A blood differential that measures the relative numbers of these different kinds of WBCs in the blood and includes information about abnormal cell structure and the presence of blasts or myeloblasts (immature white blood cells) should be done in tandem with the CBC.

The overall White Blood Cell (WBC) count is important to monitor as a significant elevation in WBC may indicate infection, lack of response to treatment, or worsening of leukemia.  Conversely, some treatments for leukemia suppress the WBC and it is important to make sure the WBC does not dip below a critical range.  The normal range for WBC is generally from 4.0 to 11.0 k/ul. 

Neutrophils are a type of white blood cell involved in fighting infection.  It is important they remain at adequate levels.  As with platelets, neutrophil levels may become depressed in patients on myelosuppressive therapy such as imatinib mesylate (also called IM, Gleevec or Glivec).  The normal range of the percentage of neutrophils is between 45% and 70%. 

More important than the percentage of neutrophils is the absolute neutrophil count (ANC), which should fall between 1.0 to 8.0 k/ul.  The reason the ANC represents the true clinical picture better than the percentage of neutrophils is that, in cases where blood counts are suppressed by therapy, the percentage of neutrophils will be higher when the overall counts are low.  One may calculate the ANC by multiplying the percentage of neutrophils (in decimal form) plus the percentage of bands (in decimal form) by the total number of white blood cells.  The number of bands is usually quite low or even zero, so one may also obtain a fairly accurate ANC by leaving the percent of bands out of the equation

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KH or Kelly Harless--a caregiver and seamate to Rob, an HSP70 Mariner Explorer

More on Counts and Blood Tests

When are low counts cause for concern? 

KH: The answer to that question depends somewhat on the individual patient, the larger clinical picture and the therapy received.  In general, for patients on imatinib mesylate therapy (Gleevec or Glivec), the following levels may warrant a decrease in dose, an interruption of therapy or the use of growth factors: WBC less than 1.0 k/ul; platelets less than 50 k/ul; hemoglobin less than 10.0 gm/dL; and ANC less than 1.0 k/ul.

It is important to note that the normal or reference range for blood counts will vary slightly between laboratories, but the following table provides a summary of the normal ranges for the counts discussed above.

Reference Ranges for Peripheral Blood Counts and Differential.

               Reference        Units     Absolute
                Range                         Count
White Cell 4.0-11.0       k/ul
Platelet   150 - 450        k/ul
Basophil     0-2                 %          0 - 0.3
                                                   k/ul
Blast           0                  %
Hemoglobin  14.0 - 17.0  gm/dL
Hematocrit   40.0-52.0      %
Neutrophil    45.0 - 70.0     %     1.0 - 8.0   
                                                   k/ul
                                                 (ANC)


How often should CBCs and blood differentials be performed? 

KH: All patients taking IM should have their blood counts monitored closely.  Complete blood counts (CBCs) should be monitored weekly in chronic phase patients during the first month of IM treatment.  If platelet counts remain over 100,000/mm³ and absolute neutrophil count (ANC) remains over 1,500/mm³, CBC monitoring can be reduced to every two weeks until 12 weeks of IM therapy has been reached.  Thereafter, if counts are stable monitoring may occur monthly or even longer if appropriate.  Patients in accelerated or blast crisis should have CBCs performed more often.

References and further reading:
http://www.labreference.com/differential.html

http://www.healthwise.org/kbase_hosp/kbase/topic/medtest/hw4260/results.htm

Deininger MW, O'Brien SG, Ford JM, Druker BJ:  Practical Management of Patients with Chronic Myeloid Leukemia Receiving Imatinib.  Journal of Clinical Oncology, Vol 21 (8):1-11, 2003.

CML  Prisms--Literature for Asian CML Support Group

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