21: Neutropenia

Yesterday, I was supposed to have the 3rd infusion of carboplatin. When they did the pre-chemo blood work, however, my white blood cell (WBC) and platelet counts were too low. There are different types of WBCs - neutrophils are the ones that fight infections. They are also the most affected by chemotherapy, so chemo patients pay particular attention to the absolute neutrophil count (ANC).

According to the American Cancer Society, the range of ANC for healthy people is 2500-6000 counts/uL. Before my chemo treatment on 6/16, my ANC was 1200 counts/uL. (Anything below 1000 counts/uL is considered neutropenic.) Yesterday morning, my ANC had decreased to 500 counts/uL. I have been careful about washing my hands and avoiding (possibly unwashed) fresh fruits and vegetables at restaurants, but after reading a bit about neutropenia, I may have underestimated the risk of being severely neutropenic. The risk of infection isn't insignificant.

This spring, I took a neulasta shot the day after each chemo treatment to help boost white blood cell production. My ANC was never low. I asked why neulasta isn't given for the current chemotherapy drug I'm on. It turns out that the insurance company will only cover the cost of neulasta shots if 1) it's a chemo drug they have "approved" because they think it is likely to cause neutropenia, or 2) you can demonstrate that you need it. On the plus side, my ANC was low enough that some neulasta-type meds were approved and covered by the insurance company. 

On the one hand, it's frustrating that medical care is often dictated by what is (and what isn't) covered by one's insurance policy. On the other hand, I'm extremely grateful that I have health insurance and that (so far) almost all of my treatments and medications have been covered. My only financial contribution has been the relatively small out-of-pocket maximum that I will be paying each year for the foreseeable future.

The current plan is to do more blood work next Thursday and (hopefully) do carboplatin treatment #3 then. In the meantime, I'll be taking shots of neupogen for the next 5 days to help increase my ANC.