07/22/09

What a typical day will be like for Christopher during chemotherapy, transplant, and engraftment

What a central line looks like (this is used instead of an IV)

As you can tell, Christopher is not a big fan of the central line. I guess that is why this one was taken out (but we will get another)!

Chemotherapy and Transplant:

Each day of chemotherapy is considered a "negative" day. The reason is, we are wiping out his immune system to get to "0" immunity. Christopher will receive his transplant on day "0". Each day after day "0" is considered a positive day. Chemotherapy "goals" are measured in positive days.

Here is our schedule as of January 8 (but things are always changing)!

Chemo is given from Day -8 to Day -1

Wednesday January 21 -  Day  0

Thursday    January 22 -  Day 0, Take 2, Transplant Day!

Transplant day is a very non eventful day. The stem cells Christopher are receiving from the umbilical cord look just like a blood transfusion! After the cords are donated the stem cells are taken out of the umbilical cord and look just like blood. After transplant day, every day is considered a "+" day. We will be looking for certain blood counts to occur at certain days.

Friday January 23  Day + 1

Saturday January 24  Day  +2

etc.....

Starting around day 14 we would hope to see engraftment occurring. Engraftment will mean his body is starting to make its own immunity and NOT rejecting the transplant.

What blood work will be taken every day and what does it mean?

Every day Christopher will have blood drawn. He will have labs including a CBC (looking at his red and white blood cell) and many others. A CBC includes a list of many types of functions happening in the blood. Although all his lab values are significant, one of the most important will be his  ANC count.

What labs we will look at:

Red Blood Cells - Carry Oxygen to different parts of the body to give energy.

Hemoglobin - In the RBC that carries Oxygen. If this number is low, Christopher may have to receive blood.

Platelets - Help stop bleeding. - If # is low, may require infusion

White Blood Cells - Help fight infections

Monocytes - A type of white blood cell that assist in the fight against bacteria and fungi that invade the body.

Lymphocytes - A type of while blood cell that helps protect the body against invading organisms by producing antibodies and regulated the immune system response.

Hematocrit (PCV) - Precentage of the blood made up of red blood cells.

*Absolute Neutrophil Count*:

Measures the amount of infection fighting White Blood Cells. If your count is below 500, it means you are susceptible to infection. If you are above 500, your body is fighting infection. 500 is the minimal number, Lets Get Christopher past 500!!!!!!!!!!!!!!

There will also be various liver and kidney labs done and a monthly bone marrow aspirate. A bone marrow aspirate will be done under sedation and they will stick a needle into his iliac crest bone (hip bone) and withdraw bone marrow.

Testing to check his enzyme levels will also be done. We will need to see if his body is producing enzyme on its own yet. This will probably be measured through urine tests.

Blood Count Graph

Each day Christopher will have his blood drawn and we will get his White Blood Cell count.  The chart below shows his progress and the various counts for each day.

WBC:  White Blood Count (Nomral Range 6000 - 17500)

ANC:  Absolute Neutrophil Count (Normal Range 1500 - 8500)

HGB:  Hemoglobin (Normal Range 11.6 - 13.6)

PLT: Platelets (Normal Range 150 to 350)

HCT (PCV): Hematocrit (Normal 33% to 39% RBC volume)

RBC:  Red Blood Count (Normal 3.7 to 5.7 million cells/mcl) - not shown on graph

Possible medications and infusions:

Medications he will be receiving will be antibiotics, antifungals, antinausea medicine, and pain medicine. He may also receive blood transfusions, platelets, plasma, and Total Parental Nutrition (if he stops eating he will receive nutrition through his central line).

**info obtained from Journal of Oncology Nursing, 2002