For the past, well, many months actually, Isa has tolerated her chemo well. So well in fact, that the oncologists raised her dosages. The combination of medicine and perhaps a cold or cough (you all know the chemo cough) have dropped her counts into the neutropenic range. 780 ANC to be exact.
Additionally, her Hgb dropped from 10 to 5.6. Those cancer parents out there know that this means we entered Transfusion Territory. Those who have read this blog realize my feelings about transfusions. BUT, really there was no getting out of this one. She was low and sometimes low is low and there ain’t no way around it.
After arriving at 10:00 am to the outpatient center we didn’t start the transfusion until 2:00 pm—after the exam, check-in, port accession, and type and cross for the blood, then having the blood sent from the bank. This reminds me that I must always pack something to do. With her neutropenia we could have spent the night “on the top floor” as the girls call it, if she’d gotten a fever from the transfusion or for any reason. Remember we pre-treat with Tylenol and Benedryl! If your child gets a fever from blood pre-treat! If we’d been admitted then I’d have no pajamas and not even an extra pair of socks in sight. Also a reminder to take nothing for granted, good is good for as long as it lasts but when in ACTIVE cancer treatment stay on your toes!
Her stomach pain and bloating had the docs concerned as well. Remember our friend VOD? And if you’ve read from the very beginning you may remember that Isa’s very first symptom was abdominal pain and bloating. After some pressing all around her tummy on Sunday proved to be painful, and slightly firm, I called Monday to change her appointment.
The nurse practitioner said that she was waiting on the stained slides (those slides that they look to see any bad cells). She didn’t mention what bad cells. They ran liver tests and a couple of other things. The NP noted that the spleen felt slightly enlarged. Just like when you take your car to the mechanic the problems disappear, Isa’s stomach bloating went down for the first time this month.
All the tests came back okay, except for the Hgb & platelets, so Isa received Vincristine and dex… (whee) but she’s off the 6-mp and Methotrexate until after her blood counts on Wednesday. We won’t be driving four hours round-trip for the blood though. Instead we’ll have it tested here in town. Every week we’ll test her blood to see if she can start her meds again.
Like I said, long-term maintenance is still active cancer treatment.
Signs of low platelets:
- unexplained bruising or excessive bruising
- bleeding that is hard to stop
- bruises that looks like a rash, also called petechiae
- nasal bleeding or mouth bleeding
- uncertainty, or fear
Signs of low hemoglobin:
- chest pain
- cold hands or feet
- desire to eat ice
- trouble concentrating
- short of breath
- pale lips
Total white blood count x % neutrophils = ANC
Risk of Infection based on the Absolute Neutrophil Count (ANC)
- ANC greater than 1500 >>>No increased risk of infection
- ANC 1000-1500 >>> Slight increased risk of infection
- ANC 500-1000 >>> Moderate increased risk of infection
- ANC 100-500 >>>> High risk of infection
- ANC less than 100 >> Extremely high risk of infection
Thanks for reading