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Coronavirus Risk: Can a Blood Test Show How Immunocompromised You Are?

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Published on March 20, 2020

Key Takeaways

  • Blood test results do not show everything; examine your history and ask yourself questions like, "How often do I get sick?" and "How long does that sickness last?" to help assess immune function.
  • Understand that the medication you're taking can be a big factor in your immune health. Take a look at the side effects of the treatment you're on and ask your doctor about your risk for infection.

As the novel coronavirus (COVID-19) continues to spread, Patient Power founder Andrew Schorr seeks to understand the risks and what precautions to take as someone living with two cancers; chronic lymphocytic leukemia and myelofibrosis. 

What are the components of immunity? What can a blood test reveal about your immune status? Watch as noted expert Dr. Susan Leclair, from the University of Massachusetts Dartmouth, breaks down test results and sheds light on what's really the most telling when determining how immunocompromised you are. 

Transcript | Coronavirus Risk: Can a Blood Test Show How Immunocompromised You Are?

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.

Editor's note: This  interview was recorded on 3/13/2020. Since then, things have changed, and Dr. Leclair would no longer visit her grandchildren. She is now using Skype or FaceTime.

Andrew Schorr:

Hello and welcome to Patient Power. Andrew Schorr here today in a rainy Southern California, and we're joined by a dear friend, Dr. Susan Leclair, super laboratory science expert, over so many decades who joins us from Dartmouth, Massachusetts. Susan, thanks for being with us.

Dr. Leclair:

You're very welcome. And, it's rainy here too.

Andrew Schorr:

Okay.

Dr. Leclair:

So you shouldn't feel too bad.

Andrew Schorr:

Okay, well and I'm wearing my, I'd say Jewish Hawaiian shirt leftover from Hanukkah, because I was supposed to be on a plane to Hawaii today for a vacation and my doctor said to me, as someone living with chronic lymphocytic leukemia and another blood related cancer, myelofibrosis scarring in the bone marrow, "Andrew, you have two conditions that affect your immune system and being on a long flight and maybe being far away, where we really would want it easily for you to get back to me..." My doctor here at UC San Diego Morris Cancer Center. "...easily that might be impaired, and so I don't think you should go. As a matter of fact, I insist you don't go."

So, what I'm doing is wearing Hawaiian-type shirts and pretending I'm in Hawaii, and it brings up the question, Susan, and I'm happy to share my test results. Many of the cancer patients served by Patient Power get blood tests and at various times we see that there are numbers that are out of whack. At least says H or L or out of the normal weight range. And, obviously we consult with our doctor and the doctor says, "Look at the trend, as to how the disease is going or how effective the treatment is." But I have a different question today for Susan. And that is, can I, the patient, look at my blood test results, and I'm happy to share mine, and get some snapshot of how immunocompromised or not I am?

Dr. Leclair:

Your immune status is composed of many different things—not only the number of immunoglobulins that you have, which is a number that you can see, not only the number of cells that you have, which is also a number you can see. But, how well either those proteins or those cells work and how well they work together. And then, there's a whole bunch of, that I've lately been calling black magic, the cytokines, the interactions at that level that we have, to put it gently, not exactly the world's most perfect tests for.

So, for a global answer, look at yourself. How often do you get sick? How long does that sickness last? Is it a, you sneeze every now and then, or is it a bronchial kind of cold or something like that? Because what you're looking at when you assess that is, the entirety of your immune function at an action level. So if you are the kind of person who every time you see your 18-month-old grandchild and you pick them up, and they kind of wipe themselves on your face and you get sick, then stay at home. If on the other hand, you babysat for this grandchild for a while or you stopped in at somebody's daycare center and you walked away with nothing and you never get sick in that sense, well then I might think about going somewhere.

When you look at the numbers, most of the people who have CLL are going to have lowered immunoglobulins, because the CLL cells aren't making them. And, the immunoglobulin is another name for antibodies. So if you've got really low, half the number that you should, or two-thirds the number of immunoglobulins  that you should, that's telling you, you're going to have a harder time defending at that level of your immune system. If you look at the white cells, if your immunoglobulins are low, the chances are that your lymphocytes are going to be low, or the lymphocytes you've got are not working. So I'm going to assume that's not a good thing.

You want to look at your neutrophils. How do they look, and what are their numbers? Neutrophils should be mostly mature. They shouldn't have any unusual inclusions or oddities to them. They shouldn't be below two. When you start getting an absolute neutrophil count, that's a 2.1, 1.8 there are not enough of them to go around. There are not enough of them to be sufficiently active to protect you. So I would look at those. Now, Andrew, you said I could use your numbers. I'm going to kind of globally do that.

You've got a slightly increased because of the myelofibrosis. You got a slightly increased neutrophil count. That's probably fine in the sense that if something were to happen, somebody sneezed at you or you had a fight with the oven and lost, as some people have done recently, then you'd get a healing that would probably be okay. So you to look at these things on a sliding scale. Your history pushes you one way or another on that sliding scale. Your immunoglobulins push you one way or another on that scale. There's no one test that's going to say, “This is going to work, this is not going to work.”

Andrew Schorr:

Okay. All right, so let's take this further in. Patient Power reaches people with many cancers. So first of all, if somebody is in active treatment, the medicines can depress certain things—whether it's a blood cancer or woman going through breast cancer treatment, things like that. So it's not just the disease and how it's affected your immunity, but it's the medicine as well, right?

Dr. Leclair:

Right. And, if you are globally speaking, this is going to be a very broad brush. So when we're looking at traditional chemotherapy, when we're looking at methotrexate (Otrexup, Xatmep, Trexallis or Rasuvo) or actually methotrexate pretty good, because it's also used for rheumatoid arthritis and other things. People that are taking methotrexate are, because of the action of that medication, written down under the contraindications and the information, are more at risk for any infection. So yeah, we're going to talk about coronavirus but I would say, I would be more afraid of somebody who is in active treatment with methotrexate and they want to go one plane ride away, two hours of a plane ride away.

I would be more afraid of the other things that they could possibly get, that are just out there—the cold, the flu and all of the other kinds of potential infective agents, because they really have a depressed system. If you're talking about some of the hormonal tests and medications that we use, for example, prostate, sometimes you use a kind of an estrogen-based drug, and in breast cancer you're using menopausal-inducing drugs.

Andrew Schorr:

That down estrogen, yeah.

Dr. Leclair:

Yeah. Those might not be as bad, because they're just going to drive you crazy, but they're not going to do anything, really, to your immune system. Once we get into the era that we're into now with drugs, anything that ends with -mib and -nib and -zumab and -mab and all the rest of them. Those you actually have to speak to your physician about, because each one of them is made to interact with one or two things. Now, if one of those two things that it interacts with, it also crosses a line and interacts with your immune system. Well, that's a different kettle of fish. So you're going to actually have to look those up. But generally speaking, standard chemo, probably don't travel. Radiation, don't travel. It is an immune suppressor, we know that. So in both of those two instances, you're just looking for trouble.

Andrew Schorr:

Okay. So back to my blood test for a minute, because we're going to share those on the screen a little bit. So I wouldn't say I freak out with all the H's and L's, highs and lows, that are out of the normal range. And, my doctors always say, "Andrew, let's look at the trend."

Dr. Leclair:

Yeah.

Andrew Schorr:

Okay. But related to that, just looking at it for me and now we can download these on our electronic medical record, which I did. And I say, "Oh my God, let me look at this as a snapshot of whether I should go to the grocery store or go anywhere." What I'm getting from you, Susan, is it's more complicated than that. And, consulting with our doctors is the way to go, because they can look at our history, they can look at yes, this blood test, but in many they can look at whether I've had colds or infections over the last year, right? So I guess that's why we need the wisdom of the person in the white coat, right?

Dr. Leclair:

It is. It is ultimately your decision. But yes, get all the information that you can. In your circumstances, and I would suggest this for everybody, unless they are going to get upset about it. Look up the side effects of the drugs that you are being given. You're not going to be guaranteed to have every single one of them. You are not guaranteed to have them at an extraordinarily significant or noticeable kind of level. But, for example, you're anemic, well, why are you anemic? You're anemic, because three of the drugs you're on have, because I looked them up, have as side effects, anemia. Oh gee, I guess that's a pretty good reason to have—and, what you've got is technically described as, you may not think it, but the rest of the medical world describes it as a mild anemia, because the numbers indicate that you shouldn't be having cardiac problems or liver problems or anything else that go along with the concept of anemia.

Andrew Schorr:

Okay. So folks, what we're talking about is the full profile of how your medicines may affect you, not just your immune system. But, I know I can't run a marathon now, because I'm mildly anemic.

Dr. Leclair:

Yeah.

Andrew Schorr:

Okay? But, maybe I can run two miles, but I can't run 26. And, that's going to vary by your conditioning, as well. But, whether I am likely to get a virus or a bacterial infection, that's more complicated. And so, I understand that, Susan. So thank you for explaining this. So just going forward, Susan, related to our worries about immunity and being immunocompromised, though clearly, and we've begun to hear this. We've said a lot on Patient Power, and we're starting to hear it in the general news, that in this time of coronavirus, we do have to be more attentive to our risk, right?

Dr. Leclair:

Yes. And, attentive does not mean black and white. The world is not black and white, as we've said any number of times. All of these diseases are grays, and they are different patterns of grays, at different times. So you have to look at yourself and say, "I'm eating well, I'm resting well, I feel good, and I'm going to go grocery shopping." Okay, make sure that when you go grocery shopping, at least in my grocery store, when you walk in, there's the sanitizer wrap. So do the bar of the grocery cart and probably restrain yourself from squeezing every single tomato before you pick it up. Just look at the one you think you'd like, pick it up, limit your general exposure to everything. And, that…

Andrew Schorr:

…wash your hands with soap.

Dr. Leclair:

Wash your hands with soap. Those pads, that at least my grocery store has got, I wash my hands with them, and then I wash the bar, and I'm off and running. Because it's—and, I probably need to say this with people because somebody's probably saying, "Well, she can be snarky, she's healthy." Actually, I'm in that high-risk group, because I have cardiac problems, and I'm of an age. We'll just leave it at that. So yes, you take those limited precautions. You just think about it. Would I want to go next Tuesday to a St. Patrick's Day activity at a local pub? Probably not. That seems too close, too many, too long. None of the grandchildren, knock on wood, are currently ill with anything. Could I go to see them? Sure. There are three of them. As long as they're healthy and nothing's going on in their community, I'm going to go. That's not a problem.

Andrew Schorr:

Okay. All right. Well, I think as we go down this road, again, all of us, who are watching this, have an oncologist, hematologist relationship, and increasingly now we're in this world of the electronic medical record and you can send messages to your clinic. You don't have to run in and go.

Dr. Leclair:

Right.

Andrew Schorr:

Always remember the nurse is a wonderful resource, and you can pick up the phone and call the nurse and say, "Here's what I'm concerned about." They can look at your blood test results, they can look at your history, you can describe your symptoms. And fortunately, me, I'm doing well right now and having fun wearing my Hawaiian shirts, even if I'm not in Hawaii. Susan, thank you so much for being with us, once again. And, your dedication over 40 years to laboratory science and devotion to people with these serious conditions. Thanks for being with us, once again.

Dr. Leclair:

You're very welcome. Anytime, you know that. You, unfortunately, know where I live and my phone number.

Andrew Schorr:

Dr. Susan Leclair, joining us from Massachusetts and both of us wishing you the best of health and reminding you that knowledge can be the best medicine of all. 

 

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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