Thursday, August 21, 2008

The Only Constant is Change

Once again things have changed. The transplant has been moved up from September 7th to September 5th, which we found out about it today as we meet with our transplant coordinator. I'm not sure what prompted the change but apparently it was decided on several days ago. I guess however, from our perspective the actual date of the transplant makes little difference because once we are in the hospital on the 29th and the chemo starts we are committed. A shift of a day or two once the preparatory chemo is underway really doesn’t change anything.

We did find out some things about Ann's donor:

She is a 33 year old female.
She is in good health.
She is has a B+ blood type.
She has elected to donate bone marrow instead of peripheral blood stem cells.
She will be donating marrow the same day that Ann is ready for transplant.

Her donor center allows us to make contact with her. Anonymously at first, then after a year we can meet her face-to-face.

In other news today:

Ann had blood work today that showed a strange result. Bear with me as I try to explain. Tuesday her WBC count was 0.1 K/uL, so low in fact that the pathologists canceled a differential count because there simply weren't enough cells to count. Between then and now Ann has been getting a 300mg shot of neupogen twice a day (morning and night) to stimulate her white cells to grow. As a result she has been having pretty constant bone pain in her hips and legs. That’s a indication that the blood cells are reacting to the neupogen and are maturing neutrophils that are migrating from inside the bones to the circulating blood pool.

So today (two days later) Ann's white count increased to 0.5 K/uL which Dr. Thomas indicated to us was a big jump. This time pathology did do a differential count on the white cells and they turned up a grand total of 25 cells for their sample. Of these 25 cells 20% were lymphocytes, 8% were neutrophils, 64% were monocytes and finally 8% were blast cells.

Dr. Thomas believes that the blasts are due to marrow regeneration. Normally during marrow regeneration only 1% maybe 2% show up as they are shoved forcibly out of the marrow nursery by adult cells pushing energetically to get out into the blood stream. She further believes that the higher than normal percentage is a result from the low amount of cells available to sample. Normally a manual differential is done with 100 cells on a slide. In this case they used 25 white cells, so 8%, or 2 cells looks like a bigger than normal percentage.

In addition she also pointed out that in previous situations where marrow regeneration showed a small percentage of blasts present Ann's counts had all but recovered. In this case 0.5 K/uL is nowhere near recovered. she backed this up by canceling a bone marrow biopsy the stem cell clinic had requested, because she said Ann's marrow would be empty. So we may just be seeing the beginning of the regeneration process and not sustained rate of blood cell production. Just to be sure she has set up a few more blood draws for next week before we see her for (hopefully) the last time next Tuesday.

Too boot Ann's twice-daily shots of neupogen have been cut to once-daily. She's relived and looking forward to not having to try to sleep through bone pain all night anymore.

Right now we re sitting in the transfusion unit as Ann gets a unit of platelets and two bags of red blood cells. Her platelets and hemoglobin were both at critical levels. As always it is taking forever because the blood bank is running short of everything this summer. No matter, Ann has discovered "Becoming Jane" on the MDA movie channel and is deeply enthralled.


Susan C said...

September 5?!? That's practically tomorrow!

I didn't know donors could select between bone marrow and peripheral blood. I wonder why a donor would choose bone marrow?

My neupogen bone pain would come in sharp outbursts and force me to shout out a loud "Oh, sh**" Of course, I was usually in public when this happened.

Nancy said...

Ann & Susan, my bone pain was achy and dull, but constant. It's weird how we all react differently. Tylenol seemed to take the edge off the pain. Hang in there! Just stay healthy so nothing can alter the transplant date. You are less than a week away from your admit date. : )
Love, Nancy

Anonymous said...

hello ann.

i havent commented for quite sometimes but really follow up wit your progress.

hope everything will goes well. sorry to hear bout the bone pain but i know you're strong.

keep up the good work to both of you.


Dori Brown said...

My donor was a 23-year old male from Europe. Jim and I hope to meet him someday. He also elected to donate marrow instead of cells and if memory serves me correctly, he moved up the date of donation, too. I think about you often and am inspired by your unwavering strength.