Pre-Transplant Work-Up

Before any transplant, there is a standard battery of tests and labs performed. Here's just a sample:

-ECHO on the heart to check on heart function and central line placement (drifting)
-PET to see the status of remaining visible cancer
-bilateral bone marrow aspiration and biopsy
-lumbar puncture into the spine
-daily blood counts

All my mother has to say is: OWCH.

For lease: Pincushion.

Walks, talks, sleeps, cooks. May run out of room for pins. $2 million OBO. May require special treatment and fluffy bedpillows.

Just kidding! I'd never give her up, but maybe I can practice phlebotomy on her...

Apheresis Round Two

Apheresis Machine

If you are curious, the basic set-up of an apheresis machine is lots of tubing, a bag of heparin (on the far left) to prevent clotting, saline and so on for hydration and fluid content (the two bags in the middle) a bag for collection of the blood stem cells (on the right with the red content), and a centrifuge in the compartment below all of the tubing. The tubing initially comes out of the Hickman line through one lumen, filters out air, separates the components of blood, mixes, and goes through the centrifuge to extract the appropriate cells by weight in some very complicated scheme which finally returns most of the blood back to the body through the second lumen. The process, particularly the centrifuge, is extremely damaging to platelets, so the medical team required (for my mother) a minimal count of 50K platelets which she reached only through a platelet transfusion.

After a lousy round of apheresis nearly two months ago, my mom was only able to cultivate a measly 2 million blood stem cells for her future transplant. The desired number was 10 million. Each transplant uses 4-5 million, but an additional 5 million would have been preserved for the situation of a relapsed cancer.

Today, my mom had a second round of apheresis, called a "double collection." Each time someone is hooked up to the apheresis machine, it's for generally two hours (depending on weight and rate and so on); a double collection would be for twice as long, so four hours.

In those four hours alone, my mom produced 12.6 million of those "little suckers" as she called her stem cells. This torture is finally over -- onto the next kind of torture!

Lesson Learned

My mom drafted her "future" schedule twice -- first to reflect the inital June transplant date, which was then amended to the hopeful May transplant date.

Unfortunately, neither date really applies now! After her third round of chemotherapy, her thrombocyte count (platelet count) was so low that to undergo her fourth round of chemotherapy would have risked her losing her bone marrow function altogether. Instead, we waited for her platelet count to slowly rise, starting from 45000 and finally hitting the Golden 125,000 three and a half weeks later, well after her scheduled date for her fourth round.

Just last night she started her fourth round. Who knows what might have happened internally during that long reprieve from chemotherapy, that length of six weeks? (Although, emotionally, physically, my mother is just about as strong as ever, as she enjoyed sleeping in her own bed, walking around, even doing a spot of gardening.)

Given that, she's learned her lesson: take things one day at a time. Forget about scheduling the transplant date; let's just mark our progress by small increments until that day does come.

On other fronts, the progress has been frustrating as well. During her initial apheresis a month ago, they hoped to collect 10 million stem cells, so they could use the optimal 5 million for her first transplant and preserve the remainder in case she relapsed and needed another transplant.

They only got 2 million, total. So she'll undergo apheresis again after this fourth round and hopefully that'll do the magic -- otherwise, they'll just have to do with the borderline collection. (Incidentially, her collection amount is not atypical; it's just frustrating.)

She also had the unfortunate incident of being given a drug to which she's allergic. Thankfully, my mother still has the presence of mind to have recognized it and then refused. However, this really highlights the arena of error in nursing and medicine (why it was ordered by the doctor and then administered by the nurse). I worry about how other patients who are either uneducated (about drug families or generic/brand names, etc.) or unable to recognize this danger as it often presents itself.