BMT: Isolation (Day +20)

Today marks 31 continuous days that we have been in BMT at UCSF (I’m not including the 2 weeks we were in Kaiser before BMT, that would be more like 45 days).  It has been one whole month of waking up to the sharp smell of disinfectant lingering in the air.  One whole month of eating bland, uninspiring hospital “food”.  One whole month of annoying beeping, snapping of rubber gloves, and medical staff bursting into the room asking “if I mind if they” do whatever needs to be done at the moment.

Ahhhh….  This will take years of alcohol therapy to forget.

To celebrate, I wanted to give you a bit of a refresher lesson on some of the abbreviations and their meanings.  It’s important to understand this when I tell you the good news!

There are several types of white blood cells (WBC). The ones we are focusing on are called Neutrophils and Lymphocytes. As you may recall, Lymphocytes are the ones that we needed the chemo to kill, because they would attack the new bone marrow. They will be one of the last WBC’s to start growing and being productive. This can take several months. The Neutrophils are one of the first parts of the new blood that we will see engrafting. The WBC’s are used to fight off infections, such as virus, bacteria or fungus. We need all of the types of WBC’s, but Neutrophils are a great start!

Absolute Neutrophil Count (ANC) is calculated with the WBC (total) and neutrophils. This is what we need be over 500, consistently over a period of 3 days.

Now the good news!  Today I received Clark’s CBC results fairly quickly. Clark’s ANC almost doubled from yesterday. It’s 4220!! That is 3 days at over 500 ANC. Can I get a booyah!!

Alright, now calm down – there is more you need to know!

To be fair, Clark is on a medication to help “boost” his white blood cells. The medication is called Granulocyte-colony stimulating factor (CGSF). Yesterday was his last day of CGSF, so we should see a slight dip in his ANC, but it should slowly continue to rise on its own after then.  Doctors assume a pullback to 3000 level, and then a continuous rise from there.

Now more good news! Clark’s platelets increased again. Yesterday he was at 38,000, and today his is up to 52,000! This is all on his own! No booster medication, no infusions… Just bone marrow doing its job.  With the increase in platelets, the doctors decided it was safe to take Clark off of his synthetic Factor XIII. He was receiving Factor XIII because of his hemophilia. Since platelets and his factor level both play an important role in stopping or preventing bleeding, Factor XIII was a good alternative while his platelets were dangerously low.  Now that his platelets are up, no more alternative necessary!

We aren’t the only ones amazed at the progress.  The doctors are also amazed at how well, and how quickly, Clark is progressing. He is progressing so nicely, that they even decided to do his Chimera test EARLY! (this is very very surprisingly good news).  The Chimera test is just a simple blood draw to find out what percent of his blood is his “old” blood, and what percentage is his “new” blood.   This is a test usually done several weeks later than now. But… the doctors are so confident (read: “soooooooo confident”), they are gambling that the new bone marrow must be the source of all these extremely high numbers.  The sample is shipped across the country to the Mayo Clinic, so we won’t have results for approximately 10 days.

And that leads us to our final piece of good news… Since Clark has met ALL criteria for going home, there apparently isn’t anything left to do, except go home.  So that’s the plan! The doctors have decided to discharge us.  We will be packing up and leaving the hospital Thursday afternoon. This is significantly early than we expected!