Day Twenty-four

            David’s checkup on Tuesday, 8 Jul, showed his white blood cell count back down to 1.9 (reference range: 4.5 to 11). Jess Driscoll, the nurse practitioner, said fluctuations are expected. He received an injection of Neupogen (filgrastim), which stimulates the bone marrow to produce white blood cells. It’s the same drug Sam received before the transplant, to increase his stem cell production. We have a supply of syringes pre-filled with Neupogen, which David can use at home, but for this week Dr. Chen judged that one dose will suffice. David’s hematocrit (HCT), the percentage of blood volume that is taken up by red blood cells, has remained fairly steady at about 30. At 208, his platelets (PLT) are in the reference range (150-400). Platelets are blood cells that stop bleeding by forming clots. They have no nucleus and are 1/5 the diameter of red blood cells.

            Jess also performed a bone marrow aspiration and biopsy, David’s fifth. The fourth was pretty rough, but this one went smoothly. His iliac crest (hipbone) is thick and strong, so it takes strength and perseverance to puncture it.

            The initial results of the aspiration and biopsy should be in next Tuesday. They will show whether or not there is leukemia and whether or not Sam’s stem cells are thriving. It’s not expected that his stem cells will have taken over at this point; we just hope it’s moving in that direction. Additional molecular testing will determine whether the mutation, FLT-3, is still present.