Red for the Holidays
The color red represents so many things, one for example, seeing red, could indicate anger, or red as in one of the most common colors associated with Christmas, or in Isa’s case the color of some of her transfusions.
For the most part, transfusions continue to be something I’d rather avoid, however, Isa’s newly diagnosed condition of Veno-occlusive disease, (VOD) or the new name sinusoidal obstructive syndrome promotes platelet destruction, thus leading to, you guessed it, platelet transfusions. So technically speaking, she’s seeing yellow, platelets aren’t red.
Now I’d love to give you more details about VOD, but quite frankly there isn’t much that describes the mild form that she has, especially associated with leukemia, because usually it is a complication associated with HIGH dose chemotherapy in bone marrow transplants. BUT, it is a RARE side effect of 6-tg or 6-thioguanine. Sometimes it has been associated with drugs like Ara-C, Cytoxan and a few others. Therefore, this is quite likely CAUSED BY THE TREATMENT. Ouch.
The only diagnostics the medical staff did were to palpate her abdomen and run more blood work for her albumin and bilirubin. She did not have any MRI or any other imaging. Additionally her urine was dark colored presumably from bilirubin discharge and perhaps blood? from the low platelets.
This condition manifests with pain in the right-upper-quadrant of the abdomen because the liver starts to enlarge. The liver enlarges because the blood gets trapped inside it as the veins start to narrow. From what I understand, some of the liver cells die. This disease confuses me somewhat. For some reason the platelets in particular are at risk. Thus, patients who suffer with VOD continue to have low platelet counts. For example, after her transfusion she could have returned from 4k to 30 or 40k, but Isa only went from 4 to 10k. Likely she will continue to require transfusions until her liver quits trapping them, and/or she has enough platelets to remain above a certain level. Supposedly mild forms of this disease resolve completely. BUT.. it is unclear how long this resolution could take.
Until then we’ll be monitoring her condition closely and subsequently will spend many hours getting transfusions until then.
- Monday-Diagnosed with VOD, Blood drawn for labs, Vincristine through port, Platelet transfusion, RBC transfusion
- Tuesday-Blood drawn for labs, PEG shots one in each leg, Platelet transfusion
- Thursday-Blood drawn for labs, Platelet transfusion, RBC transfusion
- Saturday-Because the clinic is closed we will take Isa to the EMERGENCY ROOM for her labs to be drawn and likely she will receive more transfusions.
- Monday-Clinic for labs, Vincristine through port and probably more transfusions……
Can I say that this …k… sucks?
But, the alternative reason for her liver to be enlarged could be relapse, so I suppose a case of VOD is better than that! One year ago we were dealing with an enlarged liver due to leukemia blasts.