The tartan theme continues (!) but there was a change in the weather in room 742 today. After yesterday’s transfusion, Linton’s platelet levels rose from 10 to 16, taking him into safer territory. Therefore, he didn’t need a platelet transfusion today.
The nurse told us that platelet counts are usually the last to rebound. It’s often unstable platelet levels that keep patients in the hospital a few extra days while they wait for their new platelets to show signs of being able to increase on their own, without help from donor cells.
Also, after being at 0.0 (x10^9/L) for three days in a row, Linton’s absolute neutrophil count (ANC) rose to … 0.1!
Granted, this is a teensy-weensy increase, but it does appear to be the start of the upward trend. The Fellow said that she expects it to double by tomorrow.
0.0 to 0.5 is considered severely neutropenic, and at that level patients are at serious risk for severe infections.
0.5 to 1.0 is moderate neutropenia. Once this range has been reached, patients can usually be discharged, provided their other blood cell counts (RBCs, platelets) are within an acceptable range.
It’ll be interesting to see how long it’ll take Linton’s new stem cells to churn out enough neutrophils to reach the 0.5 threshold.
Each evening, Linton continues to receive a shot of Neupogen to enhance stem cell engraftment and to hasten the neutrophil recovery.
Linton’s WBC count also increased from 0.1 (x10^9/L) to 0.4, another indication that Linton should now be able to start plotting the upswing on his graphs!
Linton was greatly relieved to see the rise, however small, in his WBC numbers. It did him an immense amount of good psychologically, too. For the last three days, I’ve been the one plotting the blood cell numbers on the graph. But today, Linton got out of bed to do it himself, and he was chuffed to be able to add the newest increasing numbers.
Fortunately, his red blood cell (RBC) counts have been declining slowly enough that he has yet to reach the critical level where he would need a RBC transfusion. Today his hemoglobin level was at 9.1, and the cut-off number for a transfusion of RBCs is 8.0.
Linton’s appetite is still quite poor, he still has moderate diarrhea, and his hair is falling out.
He still feels worn out and longs to sleep a good part of the day. But, he did manage two 10 minute walks around the ward.
And, for the first time since he was admitted almost two weeks ago, I spotted him with his laptop open ... reading a scientific journal paper (Kirchhausen’s latest!!!). So, from that alone, I knew he must be feeling a bit stronger!
He also walked with me to the doors of the unit to wave goodbye to me when I left to go home. He has had neither the energy nor the inclination to do that for some days now.
The only glitch to the day was that for about seven hours there was no running water in the hospital. There was a major mainline water break a few blocks away from the hospital, which impacted quite a large area. When the water was finally restored, it was discolored and turbid-looking, even after running it for some time. The hospital’s Infection Control department assured all units that the water was safe to use. However, the Transplant Unit felt it prudent to put a moratorium on water use until they could be triply-assured that it was safe for their immuno-suppressed patients.