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It is recommended that people taking Beta Interferons have regular blood tests to monitor any effects that the drugs may be having on their body, as some changes can occur without the person feeling anything. The World Health Organisation has come up with a grading system to categorise blood screening abnormalities depending on how serious they are, and suggest what needs to be done as a result. Your neurology team will be able to advise you further.

 

Liver function tests


WHO Grading of abnormality
( 0 is least severe,
IV is most severe)		 What does this mean in terms of blood result
Recommended action
ALT, AST, GGT and ALP Bilirubin
Grade 0 ULN    
Grade I > ULN up to 2.5 times ULN
 > ULN - 1.5 times ULN Continue treatment but monitor regularly
Grade II > 2.6 up to 5 times ULN
 1.6 - 3 times ULN Should be closely monitored or managed in a similar manner to those with grade 3
Grade III > 5 up to 20 times ULN
 3.1 - 10 times ULN The dose of beta interferon should be reduced or interrupted and cautiously reinstated when enzymes return to normal or grade I
Recurrent grade III > 5 up to 20 times ULN   The does of beta interferon should be permanently reduced or treatment should be discontinued
Grade IV > 20 times ULN
 > 10 times ULN Beta interferon should be discontinued permanently

 

White blood cell counts


WHO Grading of abnormality
(0 is least severe,
IV is most severe)		 What does this mean in terms of blood result (white blood cell count) Recommended action
Grade 0 Normal level (>4)  
Grade I 3.0 - 3.9
 Continue treatment but monitor regularly
Grade II 2.0 - 2.9
 Continue treatment but monitor regularly. If Grade II persists, the dose should be reduced (halved) until the WBCs have returned to Grade 0 or I, the full dose may then recommence at clinical discretion
Grade III 1.0 - 1.9
 Interrupt treatment (or reduce / halve dose) until the WBCs have returned to Grade 0 or I: recommence treatment at half dose and increase to full dose at clinical discretion
Grade IV < 1.0
 Interrupt treatment until WBCs have returned to Grade 0 or I and recommence treatment giving only half dose (i.e. do not return to full dose).

 

Haemoglobin levels


WHO Grading of abnormality
( 0 is least severe,
IV is most severe)

 What does this mean in terms of blood result (haemoglobin) Recommended action
Grade 0 LLN  
Grade I < LLN - 10.0g/dL
< LLN - 100g/L
< LLN - 6.2 mmol / L
 Continue treatment but monitor regularly
Grade II 8.0 - < 10.0g/dL
80 - < 100g/L
4.9 < 6.2 mmol / L
 Continue treatment but monitor regularly. If Grade II persists, the dose should be reduced (halved) until haemoglobin has returned to Grade 0 or I, the full dose may then recommence at clinical discretion
Grade III 6.5 - < 8.0g/dL
65 - < 80g/L
4.0 < 4.9 mmol / L
 Interrupt treatment (or reduce / halve dose) until haemoglobin has returned to Grade 0 or I: recommence treatment at half dose and increase to full dose at clinical discretion
Grade IV < 6.5g/dL
< 65g/L
< 4.0 mmol / L
 Interrupt treatment until haemoglobin has returned to Grade 0 or I and recommence treatment giving only half dose (i.e. do not return to full dose).