What Are Low Blood Counts?
With any kind of CML therapy, the blood counts of a patient may go low. When CML is diagnosed, there are a lot of
leukemic cells in the marrow. Drug therapy is targeted towards killing the leukemic cells. As a result, the marrow may
become depleted at first resulting in low blood counts. However, recovery of the marrow entails the production of
normal, good blood cells and when this happens, the counts recover.
Some patients still have low counts on prolonged therapy. Low counts can be defined as low neutrophils, low platelets
and low Hemoglobin. Neutrophils are our white blood cells fighting infections. Platelets are involved in blood clotting.
Hemoglobin is the oxygen carrying red blood cells. If the patient has low counts in these important cells, there can be
manifestations. Patients with low neutrophil counts may be in danger of catching infections since the infection fighting
cells are low in number. Patients with low platelets may be in danger of bruising and bleeding. Patients with low
Hemoglobin may suffer from fatigue and tiredness.
Absolute neutrophil count (ANC) is seen to be a better measure for neutrophils than neutrophil percentage by doctors.
ANC is reported in some reports or otherwise easy to calculate. ANC can be calculated by multiplying neutrophil
percentage by total WBC. For example, if the total WBC is 3.4 and neutrophil percentage is 43%, ANC will be 3.4 X
0.43 = 1.462. If ANC goes below 1, it is called neutropenia (low neutrophils) Grade 3. This is when some doctors
may stop Gleevec therapy.
Normal platelet counts in our lab is 140-450. Platelets below 100 can be classified low platelet count. Grade 3
thrombocytopenia (low platelets) is when platelets go below 50. When a patient has very low platelets, he can bleed
easily, bruise easily, have nose bleeds, etc.
Low neutrophil and low platelet count can be termed “myelosuppression” by the doctors.
Usually a Hemoglobin below 10 will be termed low hemoglobin. Grade 3 anemia (low HGB) is when HGB goes below
8. The patient may feel very tired and manifest other common symptoms of anemia.
Patients who have undergone bone marrow transplant can have low counts post-transplant. Interferon and Gleevec
patients can also have low counts. Usually, when ANC goes below 1 or platelets go below 50, some doctors may stop
Gleevec therapy. This interruption allows the marrow to recover and produce good blood cells. This is when the
suppression of counts is therapy-induced. In patients who have advanced CML and in patients where there has been
too many Gleevec interruptions, sometimes, doctors may prescribe a growth factor or booster to elevate the low counts
so that Gleevec can be continuously taken. A white cell booster is GCSF, granulocyte colony stimulating factor.
Granulocyte is another name for neutrophil. The brand name is Neupogen and there is a longer lasting version which
the patient can take at longer intervals, called Neulasta.
Unfortunately, doctors still cannot recommend a good platelet booster. There is Neumega, which is a platelet booster
but with side-effects of edema (fluid retention) and other side-effects. So, for patients with low platelet counts,
interruption of therapy and transfusions are commonly recommended.
With low HGB, most doctors in the US would recommend Procrit which is a red cell booster. There is a longer lasting
version called Aranesp which means the patient has to inject themselves at longer intervals. However, a recent trial
finding of red cell boosters to cause strokes in patients has limited prescriptions of Procrit/Aranesp in the US. In Asian
countries, due to financial constraints, transfusion is recommended for low red blood cell counts.