Day +446 : Follow-up

My Blood Count Today:
Red Blood Count (HB) = 143 (Normal 130-180)
Platelet = 168(Normal 150-450)
White Blood Count (WBC) = 6.6(Normal 4 - 11)
Absolute Neutrophil Count (ANC) = 3.828 (Normal 1.5 - 8.0)
ALT = 504(Normal 30 – 65)
AST = 202(Normal 15-37)
GGT = 666(Normal 15-85)
ALP = 222

I am fine today.

I went to UH to do my post bone marrow transplant follow-up today. The liver function test result showed mixed result. The ALT level increased tremendously, from previous level of 294 to 504, which is about 8 times exceed the normal level :-( However, the AST (232 to 202) , GGT (734 to 666) and ALP ( 305 to 222) level show slight improvement. This means that the additional Prednisolon (steroid) dosage that I took since last follow-up two weeks ago did not bring much improvement toward the liver function.

With this, doctor maintained my current dosage of Prednisolon, which is 30mg (6 tablets) per day and fixed the next follow-up to be two weeks later. If my liver condition does not improve by the time I do my next follow-up, the doctor might prescribe additional drug to suppress the graft versus host disease (GVHD), the disease that causes my liver function to deteriorate.

In fact, managing the GVHD after bone marrow transplant is like a "game play". GVHD is an effect by which the transplanted immune system (graft) is attacking the host organs. Many medications can be used to suppress the immune system so that it will not be too aggressive toward the host organs, but we cannot suppress the immune system too much until the immune system is "too weak" to clean up the leukaemic cells (if any) left in the body. In other words, we are relying on GVHD to terminate the cancer cells in the body. As such, the skill of a hematologist does not rely so much on how well he/she did the operation (bone marrow transplant does not involve much operation - cutting and sewing), but more on how well she/he manage the transplant, including the "GVHD game play".

In order to make sure that the full blood test result was available when I see the doctor in the afternoon, I went to UH as early as 6:30am in the morning to let the nurse to draw my blood. I came back at 8:30am and then went to UH again at about 1:00pm for the appointment with the hematologist. A follow-up, two visits; but it doesn't matter, it is still worth to do it as long as this gives doctor sufficient result to manage my case more promptly.

See you next post :-)