Wednesday, January 10, 2007

+162 Delayed Red Blood Count Engraftment and ABO Incompatibility

WBC 12.0 (doubled from last Thurs of 5.6)
ANC 11 (high)
Hemoglobin 8.9 (low)
Platelets 219 (yipee, normal!)
Retic 4.20 (number of baby red blood cells elevated but not too high)
Weight 12.6 (gone down b/c steroids have been reduced)

We were at Stanford for 6 hours today. The steroids were reduced to .5ml once/day. We hope no GVHD appears.

He got a blood transfusion. He was looking and acting anemic, so I took him in for labs Tuesday. They lost the test tubes (Karen issued an incident report) but by the time we came back this morning they found them. His red blood count was not extremely low (they like it above 8.0, anything below 8 is cause for a transfusion). Karen wanted to do a blood transfusion b/c he was symptomatic.

He had a 99.9 temp this morning. His WBC was elevated, which makes us think something is brewing. His temp has been going up and down, as well as his energy levels. I'm sure it's not anything serious because if it were his temp would be much higher. Dr. Dvorak ordered PCRs (various virus tests), and a Prograf level. While we've been at clinic today his temp has gone up to 99.3 and down to 97. His body is fighting something and we hope it keeps on fighting without having to take antibiotics.

His Retic count was high but does not indicate he is hemolysing (his system destroying his red blood cells). They are waiting for one more test to show if there is a lot of red blood cell waste in his system. If there is that indicates hemolysing. David's donor was a different blood type (B+) so Dr. Dvorak said that when the body is switching over to the new blood type there can be red blood cell problems. Just found a small article on ABO mismatch. One study said, "Although anti-A/B antibodies may cause hemolysis and delayed RBC engraftment after ABO-incompatible SCT, they seem not to affect the overall outcome."

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