Days +4 to +8
Another brief update.
My blood counts have progressively dropped away to where I am now neutropenic, meaning I have no immunity at all. This is the desired result of the chemotherapy regime – they want me to have no immunity so the donor cells aren’t rejected. But it does leave a window of time (i.e. prior to when the donor cells regrow and establish their own immunity) where I am particularly susceptible to infections. In fact, the vast majority of transplant patients who are within the neutropenic-window become infected at some stage, often multiple times. The most common source of infection is from my own pre-existing bacteria (e.g. gut bacteria) that have had the chance to thrive without the overlying threat of my immune system. Of course, there is also the risk of being infected by other more aggressive bacterial, viral and fungal pathogens. In a small number of these cases, these infections can be life threatening.
There can be many signs of being infected, but the main one that all the doctors and nurses are looking out for is a fever (i.e. body temperature >38°C). All fevers are treated as if they represent a life-threatening infection. Blood, urine and stool samples are taken immediately to test for pathogens and I’m put on antibiotics straight away, well before the results of the tests have been confirmed. Many/most fevers will come and go without ever knowing the cause, but if they can identify the culprit, then the doctors can modify the treatment to better target that specific pathogen and thus minimise the risk that it will get out of control. Hospitals are very safe places when you have no immunity.
In addition to becoming neutropenic, I have also become anemic (low red blood cells) and thrombocytopenic (low platelets). I must now rely on the donations from the Red Cross blood service to supplement my levels until the donor stem cells have had a chance to regrow. So far I’ve had two transfusions of red blood cells and one of platelets. A big THANK YOU goes out to all of you who choose to donate blood! This is just one example of how it saves lives.
Despite having little of my original blood system, I still feel relatively healthy and I’m in good spirits. My doctor gave me ten out of ten this morning and is very happy with my progress so far. I still have my hair and I’m still yet to develop any mouth ulcers, but I’m sure those lovely experiences will only be just around the corner. Nothing more I can do but be vigilant about my hygiene and fevers, stay active by walking the hallways of the ward, and make sure I’m eating and drinking enough each day. That’s all I can do.
