How Common Are Low Sodium and Neutrophil Counts in CDK4 and Aromatase Inhibitor ...

I've been on Cdk4/6 an aromatase inhibitors for over 8 years. Yes, my neutrophils are almost always below 2. Neutrophils are part of your white blood cells. Are your white blood cells low, too? Mine are. Since I started these treatments I can get dehydrated very easily which lowers my sodium. Drink at least 8, 8 oz of water daily. Pedialyte or Gatorade and other liquids can be substituted. My hemoglobin is usually below 12. I feel good if they are 10. If mine go below 10, I am exhausted and easily get short of breath. If they get to 7, I get a transfusion. I've had 2 transfusions. Then, I feel like I could run a marathon. One month, my CBC had every count in the red. I wake up every morning feeling marvelous. If someone asks, how are you? Marvelous with a smile.

Virginia M. I am having issues with low sodium, low chloride, and last month. My white count dropped below 2, which triggered extra tests. Neutrophils were 1.2 after 2 weeks. This month, I added extra salt to my diet and got my sodium up from 130 and my white count was back up to just below normal. My neutrophils were 1.8 after 2 weeks. My red count ussually stays slightly low.

Glenda, Pedialyte (Green label) will help with sodium, potassium and chloride. I've made myself a cheat sheet, Low sodium means I might have tingling in my finger tips, cramping in a muscle. Sodium helps balance water and minerals (potassium and chloride) in your cells. If sodium is low you're probably dehydrated. CDK4/6's side effect can be dehydration. I've struggled with it for years now. My neutrophils are 1.3, meaning I have neutropenia and a low WBC. Our immune systems are suppressed, I avoid crowded places. I go to the grocery store off peak times and wear a mask, church is a great place to pick up germs. A lot of hand shaking and hugs. I watch on zoom. Wear a mask whenever you go to doctor offices. Our cancer and treatment cause low neutropenia and anemia. The more I know, the more comfortable I am with this dis-ease. I'm here for you. You can do this. Hugs, Ginny

Virginia, I agree that sodium causes side effects. I have had to figure out what to do all on my own. I drink one Gatorade a day. I sweat way too much. My PCP insists that because of my high blood pressure, I need to be on a low salt diet. Twice I have been in the hospital. One Dr tells me I need IV because of my low sodium. The hospitalist puts me on a low sodium diet. When I was in the second time, I asked the hospitalist why I wasn't on a low sodium diet. He looked at me and said, "Why would I put someone with low blood sodium on a low sodium diet?" I go to my PCP and he writes all over my instructions low sodium diet. I made an appointment to see a new PCP but couldn't get anything until January 2925.

What i really need help with is figuring out how much salt I need a day to get to the normal range and maintain it.

I have only seen a correlation between sodium neutrophills and white count. If my white count is down so are my neutrophils. My hemoglobin hasn't dropped below 10 except when I had surgery.

Low neutrophils, low ANC, etc. are very common on this treatment plan. I take Ibrance 100mg and my CBC consistently shows slightly low numbers. This drug inhibits cell growth so the bone marrow is slow to replenish white and red cells. I’m also on exemestane (AI) so sweating at night is the norm. Luckily my electrolytes are not generally out of wack. Love the Gatorade idea. I have oligometastatic disease. One spot crops up at a time, always bone. 3 times Rx Radiation.

Sharon, my neutrophils are still low. Just not as low. What caught my attention was the drop in my white count as my sodium went down.

I hear everyone saying their WBC/neutrophils are low. Are your doctors treating this?

In my case, Ibrance was reduced from 125mg to 100mg and that change brought numbers up from an unacceptable low to an acceptable low. My #’s sit right below the low normal. No treatment necessary. We follow ANC mostly.

I am on. 75mg two weeks on two weeks off. I was changed to this when I started getting sinus infections the 3rd week of the month. Until this summer, my white count had always been around 3.5 and neutrophils were 1.2 with 2 weeks on 2 weeks off. My sodium was about 2 points low. During the heat of this summer, despite drinking water, my sodium kept dropping. Kept dropping until it hit 130, and my chloride blood levels dropped. My neutrophils stayed at about 1.2, but my white count went down to 1.8. This triggered a whole series of blood counts. This month, I increased my salt intake despite my pcp telling me it wouldn't help. I got my sodium and chloride just into the normal range, and my white count and neutrophils also came up to my ussual #'s.

Are you on a diuretic for your BP? If so, it's probably your issue.

Mary Elizabeth, WBC/neutrophils being low is very common on our treatment. Glenda said they watched them closely when her's were too low. Plus, my cancer is in my bone marrow which makes WBC so I don't make enough. This means my immune system is weak. If I get a low fever, I'm instructed to call my doctor. She'll probably put me in the hospital. I've gone to the hospital 3 times for dehydration. It's a balancing game and our bodies react differently. It's great we can share different ways to work through this journey.

This is a really thoughtful question about side effects that many people in this community may be experiencing. Lab value changes like low sodium and low neutrophil counts can happen with these treatments, but the frequency varies quite a bit from person to person and depends on many factors including dosing, other medications, and individual health factors. It would be helpful to hear from others who might be dealing with similar lab changes - sharing experiences with monitoring and managing these side effects could benefit many members here.