6 mp - Elevated White Blood Cell Count & Liver Enzymes

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expecting226
Regular Member


Date Joined Jul 2007
Total Posts : 402
   Posted 4/7/2010 8:38 AM (GMT -7)   
OK... so I have been in the midst of a very stubborn flare since August 2009.  I have been on 100 mg of 6 mp since January and it is working for me.  I am now in remission (finally!).  I have felt better than ever the last few weeks.
 
The bad news is that my GI just called and said my latest bloodwork is bad - high white blood cell count and elevated liver enzymes.  I am to stop taking the 6 mp immediately, have my blood drawn again next week, and we will take it from there.
 
Beyond being exasperated...  I am worried about the elevated count and enzymes.  I know many of you have experienced this.  Did your white blood cell count and liver enzymes go back down once you stopped taking the 6 mp?

Thanks!

Wearing many hats: Mother, Wife, Daughter, Professional, Sister, Friend
 
Current Medications:
- Asacol (4 pills, 3x per day)
- Rowasa (1 enema daily, as needed)
- Folic Acid (1 mg, 1x per day)
- Calcium (600 mg, 2x per day)
- Multi-Vitamin (1x per day)


Red_34
Forum Moderator


Date Joined Apr 2004
Total Posts : 22144
   Posted 4/7/2010 8:43 AM (GMT -7)   
Once the med gets out of your system, everything should return to normal. I just wanted to comment though that I have had both but I wasn't taken off 6mp. I just had to go in for frequent blood testing to see if the counts would go down and they did eventually. I have no idea why my WBC and liver enzyme did what they did.
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Durango Kid
Regular Member


Date Joined Jul 2009
Total Posts : 321
   Posted 4/7/2010 9:49 AM (GMT -7)   
My liver enzymes were elevated about two months into using azathioprine. I was immediately taken off the drug and retested in a month. Everything was pretty much back to normal then.
U.C. (Proctosigmoiditis) DX 2004 after quiting smoking
Currently flaring since 7/07/09 (On the mend)
CURRENT MEDS: Asacol 400mg 4x3 daily; Finally Off the evil Pred; Azathioprine 100mg (Discontinued due to elevated liver enzymes); Hydrocortisone enema nightly(tapering); Probiotic 20 billion cfu; Psillium husk powder; Fish oil; Multi-vitamin
I don't believe diet contributes to my flares, however some foods tend to irritate symptoms while flaring.


MyUC
Veteran Member


Date Joined Mar 2010
Total Posts : 640
   Posted 4/7/2010 11:48 AM (GMT -7)   
expecting226:
 
I am taking Imuran and have a pretty good understanding of these immunomodulators.  I was just wondering about your counts.  Usually the wbc will drop not rise.  I can understand about the liver enzymes rising.  What were your levels if you know?  It helps to put things into perspective.  How long have you been on it?
 
MyUC
39 Year Old Male, Dentist
Dx: Ulcerative Colitis 1996 via colonscopy and biopsy.  Pancolitis with chronic and moderate inflammation.
Started UC around 92.
Past Meds: Asacol and occasionally Prednisone
Have had 6 colonscopies throughout my hx with UC.
Current Meds: Imuran, started with 200 mg and recently lowered it to 150 mg
Most recent colonscopy 2009 after 6 months of Imuran, colon is 90% healed
Currently in remission
 
 


expecting226
Regular Member


Date Joined Jul 2007
Total Posts : 402
   Posted 4/7/2010 12:30 PM (GMT -7)   
I just read my actual report, and my white blood cell count is LOWER, not higher. The nurse said higher before she put me through to the Dr. but that was obviously incorrect. Sorry about that. My WBC is at 1000.
Current Medications:
- 6 mp (100 mg per day)
- Asacol (4 pills, 3x per day)
- Rowasa (1 enema daily, as needed)
- Folic Acid (1 mg, 1x per day)
- Calcium (600 mg, 2x per day)
- Multi-Vitamin (1x per day)


MyUC
Veteran Member


Date Joined Mar 2010
Total Posts : 640
   Posted 4/7/2010 12:53 PM (GMT -7)   
expecting226:
 
That makes alot more sense.  Your doc is right to take you off of it in my opinion.  That said your counts will bounce back now that your off of it.  What are your liver numbers?  How long have you been taking 6MP?  This all may be a blip on the radar.
 
MyUC
39 Year Old Male, Dentist
Dx: Ulcerative Colitis 1996 via colonscopy and biopsy.  Pancolitis with chronic and moderate inflammation.
Started UC around 92.
Past Meds: Asacol and occasionally Prednisone
Have had 6 colonscopies throughout my hx with UC.
Current Meds: Imuran, started with 200 mg and recently lowered it to 150 mg
Most recent colonscopy 2009 after 6 months of Imuran, colon is 90% healed
Currently in remission
 
 


Christine1946
Veteran Member


Date Joined Aug 2008
Total Posts : 5521
   Posted 4/7/2010 1:04 PM (GMT -7)   
     My white blood count dropped to 1.6 last summer when I was on 100 mgm of 6MP.  My bilirubin was twice the normal.  Didn't you feel ill at all?  I felt like crap, no pun intended.  Doctor took me off the 6MP for a few months.  My blood tests returned to normal and he tried placing me back on 50 mgm.  I was taking 50 mgm for several years, but after the first two years of remission I started flaring yearly and then more often.  Two weeks before starting Remicade, last Nov, the doctor took me off the 6MP.  Remicade failed after 3rd infusion.  Today I gave myself my second round of Humira injections....keeping my fingers crossed this works! 
 
Diagnosed with ulcerative proctitis in 1998 in hospital
Hospitalized (2nd time) in May 2008 for ten days.
Remission Nov 08 thru May of 09.
Flare May of 09 thru Aug of 09.  Very short remission.  Flared again Nov 1st.  Started Remicade Nov 18th.  Felt great after first two infusions.  Suffered a set back after 3rd infusion on Dec 31st. 
But suffered thru a 4th infusion...nada.  Starting Humira Mar 24th.


expecting226
Regular Member


Date Joined Jul 2007
Total Posts : 402
   Posted 4/7/2010 1:12 PM (GMT -7)   
I've been taking 6 mp since October 2009. I was on 50 mg from October-December, then went up to 100 mg in January and have been on that ever since.

I can't say that I feel ill... other than I am exhausted all the time. I have been complaining about that for a while now, but I am still fighting anemia, so my Drs. have attributed the fatigue to that. Sadly, my gut feels the best it has felt since August 2009. That is going to go out the window once I come off this medication. The Asacol isn't enough anymore.
Current Medications:
- 6 mp (100 mg per day)
- Asacol (4 pills, 3x per day)
- Rowasa (1 enema daily, as needed)
- Folic Acid (1 mg, 1x per day)
- Calcium (600 mg, 2x per day)
- Multi-Vitamin (1x per day)


Old Hat
Veteran Member


Date Joined Feb 2007
Total Posts : 4596
   Posted 4/7/2010 8:36 PM (GMT -7)   
Sorry to read that you've been fighting off complications, Expecting. You were doing well for a good while so I do hope your gastro can find a better med combo to secure your remission. How is Chase? (2 yrs-old in February, right ?) Did you meet Peety (also a female attorney) online here? I think she joined the forum while you were away, though. Let us know how you're doing as time/energy permit. Best wishes for you to get UC back under good control soon. / Old Hat (30 yrs with left-sided UC; presently in remission taking brandname Colazal)

expecting226
Regular Member


Date Joined Jul 2007
Total Posts : 402
   Posted 4/8/2010 7:16 AM (GMT -7)   
Old Hat! I'm so impressed you remembered me! My son is great... 2 years old now and tons of fun. Definitely keeps me busy!

MyUC - My WBC is 1.48 and by liver enzymes are 48/41.
Current Medications:
- 6 mp (100 mg per day)
- Asacol (4 pills, 3x per day)
- Rowasa (1 enema daily, as needed)
- Folic Acid (1 mg, 1x per day)
- Calcium (600 mg, 2x per day)
- Multi-Vitamin (1x per day)


MyUC
Veteran Member


Date Joined Mar 2010
Total Posts : 640
   Posted 4/8/2010 7:29 AM (GMT -7)   

expecting226:

Thanks for the information.  Again only your GI doc can give you the proper advice.  The stuff I am posting is just based on my experiences with UC.  Yes, your wbc is low but that can happen with 6MP.  Now that your off the counts will most likely normalize.  Your Liver enzymes, you should be referring to ALT and AST which are commonly tested.  There normal values are 0-40 depending on the lab you are using.  The other liver tests most commonly used are the bilirubin and the alk/phos for which the normal values are typically 40-120.  So if I understand correctly your liver values are just out of the normal range.  I talked extensively with my GI doc and he really only worries about the liver when the values are around 100 for the ALT and AST.  So I think your doc just took you off because of the low wbc which will come back.  Then he just might put you on a lower dosage.  Your liver is not out of whack so just relax.  Again your GI doc is the best person to talk to but this is my opinion.

MyUC

 


39 Year Old Male, Dentist
Dx: Ulcerative Colitis 1996 via colonscopy and biopsy.  Pancolitis with chronic and moderate inflammation.
Started UC around 92.
Past Meds: Asacol and occasionally Prednisone
Have had 6 colonscopies throughout my hx with UC.
Current Meds: Imuran, started with 200 mg and recently lowered it to 150 mg
Most recent colonscopy 2009 after 6 months of Imuran, colon is 90% healed
Currently in remission
 
 


expecting226
Regular Member


Date Joined Jul 2007
Total Posts : 402
   Posted 4/8/2010 7:44 AM (GMT -7)   
MyUC - Yes, that is exactly what my GI said. Taking me off for now mainly because of the WBC count. Once that comes back up, we will try a 50 mg dose of 6 mp with even closer supervision. If that ends with the same result, we will try Imuran.

Not feeling so stressed about it today. Just hoping to maintain this remission while we figure this out. This was the most severe and stubborn flare I have ever experienced since being diagnosed. It was particularly hard to be so sick after being in remission so long. I'm not anxious to go backwards.
Current Medications:
- 6 mp (100 mg per day)
- Asacol (4 pills, 3x per day)
- Rowasa (1 enema daily, as needed)
- Folic Acid (1 mg, 1x per day)
- Calcium (600 mg, 2x per day)
- Multi-Vitamin (1x per day)


MattHasUC
New Member


Date Joined Oct 2010
Total Posts : 2
   Posted 10/7/2010 5:38 PM (GMT -7)   
Hey Expecting,

How's the liver looking? I was just browsing the web when I ran into this same issue. I'd been on all kinds of meds (Pred tapers, handfuls of Asacol, Meselamine enemas, sulfasulazine (sp?)... that nuked my system pretty bad...), doctor finally recommended 6MP. I'm off of everything else now and have been on a 50 mg dose for a while (a few weeks)with a pred taper. After the pred was gone, the stomach stayed ok (not perfect again, but much better than it has been in about 5 years). Upped me to 100mg, and yesterday my blood tests came back with liver warning signs (ALT about 130 and AST around 90).... he's not going to take me off compeltely, just put me back at 50mg and see if it settles down over the next couple of weeks. God I hope so, this has seemed to be the miracle drug for me, would hate to have to consider surgery to fix my UC..... I had been in a constant flare for about 5 years, was glad to finally be rid of it. Having 1-2 BMs a day is such a relief after 5 years of always tracking down every bathroom in any new building before being able to do anything else....

Anyways, let me know how you're feeling now, and if they still have you on the 6MP. I'm just looking for some good news, :-D

-Matt
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