First transfusion

Malcolm is doing great. His eating is still a bit off but he is drinking well and has quite a bit of energy. He needed a platelet transfusion today. Platelets are the part of your blood that makes it clot. His platelets have been low since last fall, fluctuating between 30 and 124 (the normal range is 150 - 400). They were 42 when chemo started and yesterday were 20. They were 16 this morning before the transfusion and we will see what they are tomorrow - they will definitely be higher but each patient responds differently so difficult to predict how much higher. He may need a platelet transfusion after every round of chemo - this is very normal. They typically transfuse when the count drops below 20 as they try to avoid them dropping below 10. At below 10, they are at risk for internal bleeding, particularly in the brain.

His hemoglobin (red blood cells, which are responsible for carrying oxygen throughout the body) is also dropping and it is possible he will need a transfusion later this week. They were 90 today and they typically transfuse if they fall below 70 (the normal range is 105 to 135).

The most important count of all is his white blood count which indicates his immunity. They look at his Absolute Neutrophil Count (ANC) and consider anything above 1,500 to be ok (a neutrophil is a type of white blood cell). 1,500 to 1,000 would mean he is mildly neutropenic. Between 1,000 and 500 would mean he is moderately neutropenic and below 500 would mean he is severely neutropenic and at high risk for developing a life-threatening infection. His ANC was 1,000 today. He has been started on an antibiotic to help guard against fungal infections, which are common among neutropenic patients. He now has a special mouthrinse that I swab around his mouth four times a day to help prevent mouth sores, which are also very common. He will soon begin getting another antibiotic twice a week to help prevent bacterial infection.

He went home again yesterday and today after his nap on a day pass. It is so nice to be able to eat together as a family at home. I bring him back to the hospital at bedtime. He is hooked up to fluids while sleeping but is otherwise free of the dreaded IV pole. I believe the doctor intends to continue letting him go home for short periods until his ANC drops to around 500 (or unless he feels unwell). Fingers crossed he will be allowed to go home again tomorrow!

Mary Ellen