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Early November 2005

Posted Jan 14 2009 8:35pm
After the cyclosporine was cut down, things were ok for a couple of days. As expected, Richard's blood counts began to drop. He didn't look too pretty. His face was bruised from the fall and his feet were very puffy. He and I both got really tired of the nurses and doctors asking him if he was keeping his feet elevated. Now I wish we had taken pictures, but it never occurred to us at the time.

Transplant patients get very obsessive about their blood counts. Here's a part of the spread sheet record I kept on my PDA.
For the unfamiliar, normal hemoglobin (Hgb) is about 12 depending on the lab. Normal white blood count (WBC) is over 4.5, normal platelets over 150,000. More about magnesium and creatinine later.

The main focus in the first two to three weeks is on the WBC. It is expected to drop very low. In an autologous transplant the patient is given a medication, granulocyte colony stimulating factor (G-CSF) to stimulate the bone marrow to begin to produce again. In an allogenic transplant, G-GSF is not given. Methotrexate is given to delay the return of the marrow function. This is thought to prevent rejection of donor stem cells and early GVHD.

During this time of depressed marrow function, the patient is at high risk for infection. Any fevers are treated very agressively. Richard had several blood and platelet transfusions which is pretty standard for most patients.
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