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Which Lab Tests Are Essential for CLL Patients?

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Published on July 31, 2017

Which Blood Tests Should CLL Patients Receive?

Chronic lymphocytic leukemia (CLL) patients are required to get blood tests often. Which tests should they be receiving? Which lab results should CLL patients be concerned about? Andrew Schorr, Patient Power founder and CLL patient, is joined by laboratory scientist Dr. Susan Leclair and CLL expert Dr. Thomas Kipps to discuss which blood tests are most important to CLL patients.


Transcript | Which Lab Tests Are Essential for CLL Patients?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

What Are the Essential Blood Tests for CLL?

Andrew Schorr:
Now, I have blood tests often, as many people who have been living longer and living pretty well, thank God, with CLL, but we get poked.  They know us at the local lab, and come back with a lot of numbers and highs and lows, and we've talked about that in other programs.  What does it mean, and what tests do we have?  And every once in a while, maybe, you're going to have like I have had the last two years running, about a year apart, a bone marrow biopsy.  What does it all mean? 

So first of all, I want to start with you, Dr. Kipps, you were talking as we were getting ready for this program about tests and assays and things like that.  It's not just about whether there's a test, but it's about what's meaningful, right?  So how do we as the patients not get strung out, if you will, about some number but work with our doctor on what's significant? 

Dr. Kipps:
That's a very important question, and this is a very important topic.  As you know, there are essential tests that I think we need to use for monitoring how well we're doing and relevant to CLL, of course, is the complete blood count, the CBC. And that is very important and should be done in follow-up, because it gives you information about the white blood cell count, the types of white cells that are in the white cell count. 

It's also very important to know what your hemoglobin is.  That's the protein that carries oxygen in the blood to the tissues. And if that gets down to a low number, then we are not having sufficient blood supply to the tissues, and we experience fatigue and other symptoms, and then, of course, the platelet count. 

Those are three things I mentioned, the white blood cell count, the hemoglobin and platelet count, are the critical parameters within the complete blood count, and there are some other tests within the complete blood count that we can get into.  But it's important I think the patient to pay attention to those values.  We typically like to look at the white blood cell count, because there can be changes that reflect infection or progression of the disease.  We like to pay attention to hemoglobin, because that can affect your performance. 

It's interesting though that the hemoglobin is, when it goes down lower we have less oxygen?carrying capacity to the blood. But the body is so well designed that when the hemoglobin goes down and the red cell count goes down, our blood becomes actually more free?flowing.  It becomes less viscous, and as a consequence it kind of compensates for a lower hemoglobin.  But when the hemoglobin values get below 11 and particularly below 10, then we can start experiencing symptoms as if we were at a higher elevation, say, at 5? or 7,000 feet. 

And, of course, the platelet count is very important too, because these are the patches which can stop bleeding if you cut yourself. And when it gets down to a critically low level, below say 20,000 or below even 10,000, then we run the risk of spontaneous bleeding provided we're not taking medicines that can affect the function of the platelets, which can actually occur at higher platelet counts.  

Andrew Schorr:
One other question was about neutrophils.  So I think those of us who have been living with CLL for a long time, and you have me carry my azithromycin (Zithromax) around with me, we know that infection is really big risk for us. 

Dr. Kipps:
That's a very important point.  I think the white blood cell, the white blood cells are all not the same.  There are some that are the work horses of our response to infections, the neutrophils.  They're like the fire trucks. And if we don't have fire trucks in the fire stations, we can't put out fires.  And the neutrophils serve that purpose.  So if we get a sliver in our finger or have inhaled some bacteria, then the neutrophils home to the site of the infection, and they provide our primary first line of defense. 

And we oftentimes hear there's no magic number in medicine, but typically we like to maintain a neutrophil count above 1,000.  When it's below 1,000, we get more concerned that your response is going to be inadequate or too slow to take care of an infection before it becomes an overwhelming infection.  So it's important to pay attention to our neutrophil count. 

We also pay attention in CLL to the lymphocyte count, and by and large the lymphocyte count, if the lymphocyte count is elevated above, say, 5,000, then primarily the lymphocytes are mostly your CLL cells although other cells can contribute to this.  And the higher the white blood cell count the greater proportion of the lymphocytes will be the CLL cells, and it becomes like a leukemia cell count. 

We typically monitor the leukemia cell count over time, and we kind of calculate what's called a lymphocyte doubling time.  And what that is is how long does it take for the lymphocyte count to double up.  Is it—we've had patients double their lymphocyte count in two weeks.  We've had some patients, quite a few, that we are hard-pressed to define how long it's going to take for the lymphocyte count to double. 

We like to monitor this, because typically this goes along an exponential curve, and it gets higher and higher if there's clear disease progression.  And you can take many data points, and you can ignore some of the noise that you get on day?to?day variations and try to extrapolate, and you can also use that to predict where you might be.  We say if the lymphocyte doubling time is less than six months, it becomes relatively easy to say that we probably are going to require therapy relatively soon.  

And among the experts we've debated whether it should be a lymphocyte doubling time of less than a year, and I think that I use personally the metric of a year, because in my experience it's very unusual for patients who have lymphocyte times of less than a year, doubling times, that it reaches a plateau where it ceases to go up and up like you would predict.  But I've seen that with patients who have lymphocyte doubling times of greater than a year where sometimes patients may hit a plateau, and they're feeling fine, and I don't see progression in their lymph nodes. And even if it's elevated up to what we can consider very high levels, I don't get too excited about it if the counts are staying stable and the patient is doing well. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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