Imuran makes white blood cells low need advice

As the title says my rheumatologist called and said I need to immediately stop imuran as my white blood count is dangerously low. What does that mean? What can happen? She mentioned bone marrow too? Please help me understand this and is there something I can do? I want to go back on azathioprine. I am at 50 kg and I was on 150 mg. I'm thinking maybe I was on a too high dose for my weight. Last time I was on 150 mg I weighed 65 kg. Please help and advice. Thanks

I had that happen to me with 6mp and I had to stop for a while. I was able to restart on a very low dose with allopurinol and I took it for quite a while, but my numbers went up and down and I did have to be careful about infections. They tried to get me to do a bone marrow test but I said no. It looked like it would be painful to have them extract with that crazy needle. You should go to a hematologist, but I wouldn't do that other test unless they are 100% sure it's necessary. My numbers bounced back once I stopped 6mp. Have you considered mtx? Maybe that would be better for your arthritis if it's an option.

What's your WBC value, and what does your test consider to be a normal range?

>my white blood count is dangerously low. What does that mean?
The reason we get our blood tested while on azathiopurine/imuran/6MP is exactly because of this. At any time, our blood vales WBC, RBC, platelets, Neutrophils, etc) can drop to low levels. That can happen when first starting Imuran or years later.

>She mentioned bone marrow too?
Imuran slows the level in which our body can make new WBCs and it does this by acting on bone marrow (which is where all of those blood elements are manufactured within our bodies). Your bone marrow is fine. The medicine is acting too strongly within your body, causing more suppression than is desired. It's called Myelosuppression in medical jargon. Ceasing or reducing dosage of Imuran will restore you to normal blood test results in approximately 6-8 weeks.

This happened to me with Neutrophils. I had been on 6MP about 2 years, then my Neutrophils starting trending lower, we watched it over a series of months. Doc said let's reduce your dosage from 75mgs to 50mgs. We did that and about 6-8 weeks later my numbers returned to normal levels. I staid at 50mgs for another 6-months then was able to go back up to 75mgs and remained there for additional years.

>What can happen?
You are more at risk of infections normally, and that risk jumps if your WBCs are very low. WBCs are your immune system's attack dog, eliminating things that cause infections from our bodies. With low WBCs your body is less able to fight off infections. I would be more cautious around those that are sick, and use good hand washing practice. If you suspect you have an infection needing antibiotics (UTI, bronchitis, sinus, etc) then you should see your doctor promptly for antibiotics. Worstcase scenario is Sepsis, an infection spreading and becoming blood born, unlikely. NSSG had sepsis and was in ICU, it's pretty scary crap. Do not mean to scare you, but do want you to be aware of all likelihoods even those that are low risk.

>is there something I can do? I want to go back on azathioprine.
Be cautious about infections/cold/flu, wait 6-8 weeks, and then watch your future blood tests. I was fine, and I imagine you will be too. So do not panic.

As far as your future treatment with Imuran goes, I'd wait until your WBCs come back to normal levels. Then you can discuss restarting at a lower dosage with more frequent blood work for a while. Your doc may be for this or against this. Depends on more variables than you've shared (history, doc preference, other blood values, etc).

A couple mentions of Allopurinol, to clarify its usage. Allopurinol is meant for hepatoxicity, which is to say you cannot get up to ideal therapeutic (healing) range due to your liver enzymes being raised (so allopurinol plus Imuran at a low dosage enables you to safely get to therapeutic range without the liver issues). Andrina has the opposite problem, she's metabolizing the imuran too well and there are no liver enzymes at all present. Reducing dosage would be the 1st approach to safely take Imuran again, from my understanding.

Thank you for all your replies I appreciate it

I was on 100 mg first and my blood work seemed fine. I plan on asking her if I can be on 100 mg.

John, according to your math I should be on 100-125 mg (50 kg). She called me today and I told her exactly that. That my blood work was good on 100 mg and that I think I was on the wrong dose for me weight. Luckily she agreed and next week we'll repeat the blood work and if it looks good she'll allow me to restart Azathioprine on 100 mg. I'm so happy and relieved. I hope this time it will stay OK.

It was 2 and is now 3.6. Not sure about the normal range but 2 was too low.

notsosicklygirl said...
If you can take a lower dose of imuran it may not make your WBC so low. That's why i thought maybe allopurinol would help. Maybe not though. I do know that I didn't have WBC problems when I was on the lower dose with the allopurinol. Before, on the higher dose, I had the problem. I had sepsis when I was on MTX, no 6mp/imuran.

How did they clear the sepsis?