Counts, Counts, & more Counts

sadie needed blood in this pic

In this and the following pics, sadie was in desperate need for a platelet tranfusion.  The night before these pics were taken, she went to bed with not a bruise on her.  The next morning I woke up and saw this.  These bruises multiplied and intensified in the short time it took us to get her to the hospital and transfused.  The bruises shown here are nothing compared to what they turned out to be that day.  Sadly, they actually look good in these pics. 

Sadie has a CBC with a DIFF done at least once a week and every morning at 5:00am during most hospital stays.  If she needs one done on one of her off chemo days when were not due in clinic, we go to a local lab like quest and they take the blood through a finger poke draw.  Usually the blood is taken through her port, but when we go local, they poke her finger and squeeze the blood out in a tube.  Naturally, she hates this, but she is so brave.  A CBC is a complete blood count and it measures things like her hemoglobin, red blood cells, etc.  The most important of these is her hemoglobin, platelet count and her white blood cell count.  We were given the warning signs to look for so we can pinpoint if any of these are low.  At first it was scary, and at times it still is being responsible for that, but we almost have it down to a science.  Counts change so quickly and rapidly from day to day, so ya never know what its gonna be tomorrow. Low hemoglobin makes you anemic, so your tired, pale, dizzy, no energy, fast heart rate, low oxygen. Low platelets as I said earlier make you bruise at the slightest touch and bleed internally and out.  Low white cells which are our infection fighting cells increase risk of infections, and cause fevers.  Any time throughout our treatment if Sadie runs a fever of 100.4 for more than an hour or has a single temp of 101.0 or higher, she has to come in to the hospital for at least a three day stay.  Blood is taken and cultured and antibiotics are started immediately.  Normal range for Hemoglobin is 11.5-13.5.  blood is transfused at a 7-7.5.  Sadies lowest has been a 6.5.  They try to hold out transfusing anything until the last possible moment because a persons body can either reject blood and/or platelets or become dependent on them.  Huge risks are involved when tranfusing anything.  A blood transfusion is supposed to last for up to two months, but when given to someone who recieves weekly sometimes daily chemo, the body eats it up within a few weeks.  Normal platelet range is 100,000-400,000.  Sadies lowest thus far have been at 8,000.  SEVERELY LOW.  Usually 20,000 is the transfusion mark unless bleeding and severe briusing occur before then.  Platelets are wierd, not everybody can donate them, and there life span is roughly 10 days.  If you have bone marrow that functions properly then thats not a problem because new ones would always be produced. In sadies case, her cancer starts in the bone marrow and affects its function.  A persons bone marrow produces all the cells and blood in ones body.  The point of the chemo is to continually suppress the bone marrow so the cancer doesnt have a chance to spread.  The medicine wipes her bone marrow out, lets it repair a little, and then shes wiped out again.  White blood cells are most important.  Normal range is 5.5K-15.5K.  Leukemia takes place when a single white blood cell becomes deformed in a sense and multiplies into blasts(cancer cells).  At diagnoses her white count was 40,000 but 80% of those were full blown blasts.  Her white count has been as low as 0.1.  This is where the DIFF part of the CBC comes in.  The DIFF (differential), tells me the morphology of her cells (size, shape, etc), and what her bone marrow is doing.  For example, we all have segs and bands.  These segs and bands tronsform into white cells.  Mono cells turn into segs and bands which then turn into whites.  The point of the Diff is to determine her ANC score.  An ANC score is our absolute neutrophil count.  Our neutrophils are our segs, bands, monos, etc.  An ANC tells us our immunity to infection. A healthy persons ANC is thousands, sadies has been at a 0.  The ANC is caculated by taking the white cell count, moving the decimal over one and multiplying it by the segs and bands.  So........say your white cell count is 14.2 and you have 40 segs and 20 bands.  Your 14.2 would become 142 after you move the decimal and that number would be multiplied by 60 cause thats the total of the bands and segs.  Your ANC would be 8,520.  You'd be kicking ass.  The ANC is so important.  Most cancer patients die of a secondary infection instead of the cancer itself.  When your white count is low and your ANC sucks, the risk of picking up an illness is huge.  Your common cold could be deadly to my liitle girl.  When it becomes too low and stays low, you can then infect yourself.  We all have bacteria on our skin, but it doesnt phase us, cause we have a white count and immunity.  Cancer patients dont, so there own skin can become a danger to them, as can there own insides (the intestines, the bowels, etc)  This is why Sadie cant be around other children, public places, groups of people.  We were told to not even take her out of her own environment for the risk of breathing in something airborn that you or I would not even know was there.  This is why im such a germaphobe, this is what I stress on, this is why I lose my mind.  Counts, Counts, Counts.  I talk alot about them and for those of you that take an interest in the logistic part of this will now understand what im talking about when i start rattling them off. Cant start chemo treatments unless we make certain counts, cant fight the cancer without the treatments.  Delays in treatment are scary.  There is then nothing there to suppress the bone marrow and keep the cancer away.  The majority of you are probably like what the hell did she just say???  I hate counts...............................