Day +27

WBC 1500
ANC 1390
Platelets 36k
Hemoglobin 10.5
Weight 11.9 kilos
Temp 36.4 (97.4)

His temp is normal. He's had 3 doses (10mg each) of steroids but the appetite has not increased. He is not eating anything but breastmilk and occasionally milk or superfood. He is moody and cries easily, wants things a certain way and if they are not that way he screams. He chucked his toy and a book across the room twice this morning. His immune system is even more suppressed now. He is especially susceptible to viral and bacterial flareups. Lizzie said bacteria and viruses may reside in him that will surface with a suppressed immune system. We pray not.

Question of the day: What is happening when I say GVHD? Right now it's severe acute GVHD, Grade III. The severe acute GVHD rash is based on how much of the body the rash covers. In his case it's over 75% of the body. What's happening is that the donor cells are attacking his tissues, specifically, the skin in this case. The steroids slow/stop that attack. At some point (we pray hard) the donor cells stop attacking and take residence. As they taper off the steroids (which could be up to months) they look for the rash to return. If it does not return, that means the donor cells are taking up residence, and he is on the road to a successful graft. It's very common with unrelated donors to get some type of GVHD. David's rash was not that bad. Although, it is considered severe acute GVHD, Grade III. His did not itch, it did not blister, it did not bother him. I praise God for those blessings! Also, there are no GI problems or liver problems. If the rash does not respond to the steroids within one week, we have a big problem, like chronic GVHD.

Second Question of the Day: When will we go home? There are two main goals: get the GVHD under control and transition all the IV meds to oral. It takes time to make the oral meds therapeutic for him. We will transition the Fluconozol (prevents fungal infections) today. We will be here at least more two weeks.