Day +215

My Blood Count Today:
Red Blood Count (RBC) = 128(Normal 130-180)
Platelet = 130(Normal 150-450)
White Blood Count (WBC) = 3.4(Normal 4 - 11)
Absolute Neutrophil Count (ANC) = 1.904 (Normal 1.5 - 8.0)
Potassium = 4.4(Normal 3.5 - 5.2)
ALT = 122(Normal < 51 )
AST = 56(Normal < 41)

I am fine today. I went to do my post-transplant follow-up this morning. My blood result was more or less the same as the last visit, which was very close to normal count.

My ALT level is now 122; more than twice the normal level. ALT (Alanine Aminotransferase) is a type of enzyme produced within the liver cells. As the liver cells are damaged, the ALT leaks into the blood stream leading to a rise of ALT level in the blood. With this, ALT level is used as a health indicator of the liver. Likewise, the AST (Asparate Aminotransferase) is also an enzyme which level in the blood can be used to gauge the health of our liver.

Doctor suspected that the elevated ALT and AST level is due to GVHD (Graft Versus Host Disease). In other words, my immune system (borrowed from my sister) starts to attack the liver.

Is it bad to have this? No, no. In fact, doctors and nurses told me many times that a minor GVHD is good because it shows that the new immune system is attacking something in the body. With this, we assume that it would also attack the remaining cancer cells in the body, an effect also called Graft Versus Leukaemia (GVL).

A few days ago, I told a BMT (Bone Marrow Transplant) nurse that my body showed no sign of GVHD. “No good,” she responded without any hesitation. This made me to cast doubt on the effectiveness the transplant. It also leads to a question, “Does GVL has to be manifested through GVHD?” When I posted this question to doctor, the answer I got was that there is no way we know for sure if GVL has taken place in the body. However, it is generally assume that if GVHD happens, GVL also happens.

I no longer need to worry too much now because there is sign of GVHD. Apart from elevated ALT and AST level, doctor also spotted white spots in my mouth and throat which she believed is another sign of GVHD. “At least it shows something,” she said :-)

Due to possible GVHD effect, doctor reduced the follow-up interval to 3 weeks instead of 4 weeks.

See you next post :-)