My Blood Count Today: - Readings in square bracket [] are result from previous test.
[Compared to the result on 2, April 2009 – ColumbiaAsia]
Red Blood Count (HB) = 144[157] (Normal 130-180)
Platelet = 210[132] (Normal 150-450)
White Blood Count (WBC) = 4.4[3.5] (Normal 4 - 11)
Absolute Neutrophil Count (ANC) = 2.024[0.9] (Normal 1.5 - 8.0)
[Compared to the result on 2, March 2009 - UH]
ALT = 66[88] (Normal 30 – 65)
AST = 42[57] (Normal 15-37)
GGT = 36[82] (Normal 15-85)
I am fine today.
The blood count results have improved significantly compared to results on 2, April 2009. All counts are within the normal range now. Dr. Gan said the heavy drop of platelet, white blood count and ANC of last blood test might be due to viral infection, as I was sick that time.
The liver function test result also improved and all readings are almost in the normal range.
Dr. Gan said my lung condition might due to chronic GVHD. However, she would not start any treatment until she sees result of the high resolution CT scan scheduled on 18 June. She referred my lung condition as BOOP/BO instead of Bronchioectasis, terms that I came across the first time.
Bronchiolitis obliterans, or Constrictive bronchiolitis, one form of which is called Popcorn Workers' Lung or popcorn lung, is a rare and life-threatening form of non-reversible obstructive lung disease in which the bronchioles (small airway branches) are plugged with granulation tissue.
Bronchiolitis means inflammation of the bronchioles and Obliterans refers to the fact that the inflammation of the bronchioles partially obliterates the airways. [Wikipedia]
Bronchiolitis obliterans organizing pneumonia (BOOP) is an inflammation of the bronchioles (bronchiolitis)[1] and surrounding tissue in the lungs. BOOP is often caused by a pre-existing chronic inflammatory disease like rheumatoid arthritis. BOOP can also be a side effect of certain medicinal drugs, e.g. amiodarone. [Wikipedia]
I found a article that describes the possible post-transplant lung issues which include BOOP/BO. The article can be accessed here.
The difference between BOOP/BO, according to the article:
BO is generally a disease of the small airways, where the small airways become narrower presumably due to GVHD, to the point that airflow is limited through the airways. On lung function testing, this appears as an obstructive pattern. When detected, BO is usually severe and generally irreversible. The goal of therapy with immunosuppression is to prevent progression. Unfortunately, BO is often "silent" and clinically unnoticed until it is severe. BO is generally not detectable using standard chest X-ray or CT, but can be detected using a high resolution CT scan. Respiratory infections can also cause airflow obstruction, so patients generally need a bronchoscopy to make sure an infection is not present before initiation of therapy. Therefore, our efforts here have focused on how to identify patients earlier, so treatment may be started to stop the progression of BO before it becomes severe. BOOP is an inflammatory disease that involves the small airways and the alveoli, the gas exchanging units in the lungs. Most commonly, this results in a restrictive pattern on lung function testing, which means that the lungs cannot expand well. BOOP is detectable using a CT scan or chest X-ray. However, because it looks like pneumonia, additional studies such as bronchoscopy and lung biopsy are usually necessary to confirm the diagnosis. BOOP differs from BO in that it is very responsive to immunosuppressive therapy. Most BOOP cases are completely reversible, although a small percentage of the population will have steroid resistant or dependent BOOP.
It is not sure which one do I have at the moment but I believe that my symptom is more toward BOOP as I can feel that the elasticity of my lung is greatly reduced – very restrictive and couldn’t expand well. If this is the case, then there is hope for complete recovery, perhaps with the steroid (Prednisolon) treatment again.
When doctor examined my abdomen, she noticed that my skin is getting very tough. This might be an indication of GVHD too.
I also sought her advice whether I should go ahead with the pneumonia and flu vaccinations as suggested by the lung specialist. She said that it is not advisable for one who has active GVHD to have vaccination. Since it is not sure whether I have active GVHD at the moment, she advised me to have the pneumonia vaccination first.
I will most probably do the vaccination during my next follow-up at haematology clinic which is scheduled 4 weeks later.
See you next post :-)
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