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
The Basophils should remain within the normal range, generally between 0% and 2%. Some clinicians believe that, as in the case of neutrophils, the absolute basophil count is more important than the percentage of basophils and should fall between 0 to 0.3 k/ul. The absolute basophil count is calculated by multiplying the percentage of basophils (in decimal form) by the total number of white blood cells.
One should monitor blasts in the peripheral blood . Blasts are immature white blood cells and individuals with leukemia have an excessive number of blasts in their peripheral blood and bone marrow. With appropriate treatment, there should not be any blasts in the peripheral blood and fewer than 5% in a bone marrow aspirate .
Platelets also constitute an important component in the hematological picture for a CML patient. An escalated and uncontrolled platelet count may indicate disease progression and is cause for concern. In general, with appropriate treatment, platelet levels should fall within the normal range (150 to 450 k/ul) without platelet-lowering medication. Platelet levels may be depressed in patients on myelosuppressive therapy such as IM and it is important they remain at adequate levels.
Finally, one should keep an eye on hemoglobin and hematocrit counts. If one’s treatment suppresses the counts, it is important not to become too anemic . Normal hemoglobin levels range from 14.0 to 17.0 gm/dL and the hematocrit value should fall between 40.0% and 52.0%.
When are low counts cause for concern? 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.
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
The Basophils should remain within the normal range, generally between 0% and 2%. Some clinicians believe that, as in the case of neutrophils, the absolute basophil count is more important than the percentage of basophils and should fall between 0 to 0.3 k/ul. The absolute basophil count is calculated by multiplying the percentage of basophils (in decimal form) by the total number of white blood cells.
One should monitor blasts in the peripheral blood . Blasts are immature white blood cells and individuals with leukemia have an excessive number of blasts in their peripheral blood and bone marrow. With appropriate treatment, there should not be any blasts in the peripheral blood and fewer than 5% in a bone marrow aspirate .
Platelets also constitute an important component in the hematological picture for a CML patient. An escalated and uncontrolled platelet count may indicate disease progression and is cause for concern. In general, with appropriate treatment, platelet levels should fall within the normal range (150 to 450 k/ul) without platelet-lowering medication. Platelet levels may be depressed in patients on myelosuppressive therapy such as IM and it is important they remain at adequate levels.
Finally, one should keep an eye on hemoglobin and hematocrit counts. If one’s treatment suppresses the counts, it is important not to become too anemic . Normal hemoglobin levels range from 14.0 to 17.0 gm/dL and the hematocrit value should fall between 40.0% and 52.0%.
When are low counts cause for concern? 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 Range |
Units |
Absolute Count |
|
White Cell Count
|
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
|
How often should CBCs and blood differentials be performed? 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/mm 3 and absolute neutrophil count (ANC) remains over 1,500/mm 3 , 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.
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