Sunday, August 17, 2008

Crashing Counts

When we saw Dr. Thomas last week after Ann got out of the hospital, her white count was riding around 9.8 K/uL about 90% of which were neutrophils. Post chemotherapy you would expect a reduction in the white count, because cytotoxic drugs kill leukocytes but in Ann's case she was experiencing a gradual rise. I was curious about the contradiction, so we asked Dr. Thomas about it.

It turns out that the modified Hyper-CVAD protocol Ann is getting is heavier on steroids that when we did this over a year ago. Some of which cause a temporary increase in the WBC count. As Dr. Thomas explained, this increase is quickly followed by a massive die off as the chemotherapy drugs begin to work. The exact timing of this shift from production to reduction varies from person to person. So normally the clinic adds extra appointments to monitor the person's blood work until the counts begin to recover.

Yesterday we had one of those extra appointments, and sure enough Ann's counts not only dropped they crashed. In fact her counts crashed so hard that the pathology lab had to check her blood sample twice to make sure she was OK. Most of the time I can tell if there is a problem, because the turn-around on MDA's tests is normally super fast. Any delay suggests that something isn't right.

When the results finally did turn up they showed that, along with a general reduction in all counts across the board, her WBC count had dropped to 0.3 K/uL. The most interesting result however, was that her RBC count came back as "undetectable" while her hemoglobin was registering at 10.3 G/dL, which is well above the level for anemia. Also her platelets were on the border line (20 K/uL) so they set up a transfusion of two units.

So most of yesterday was spent waiting for results or getting a transfusion. I'm much more concerned about what is going on in the Stem Cell Clinic right now. The old anxiety is starting to creep back in because we haven't heard anything. Last time we talked to Dr. Kebraei she told us that they were working on arranging a date for the donor to come in and donate. That implies that the donor agreed to donate and has tested as healthy enough to do so. I forgot to ask if that was specifically the case though.

I don't want to hound the Stem Cell Clinic for answers, but last week we were on a three week count down. Next week it will be two weeks left. I really think we need some kind of update on how things are moving along.

1 comment:

Susan C said...

My vote is for hounding the stem cell clinic for answers.

From what I've heard from another patient at MDA, patient communication is not that department's strong suit.