My mother's neutrophils seemed to recover quite well on Monday with a count of 2.5. However her hemoglobin went down to 7.5 and platelets were at 24, so she received both blood and platelets that day.
Thursday her ANC was 1.6 again though. I am not sure why the drop, perhaps it has something to do with receiving non-HLA platelets? I know this is still a pretty good ANC in the context of AA. It's just very hard to not ascribe meaning to every little fluctuation in blood counts. She has never had to have Neupogen as her ANC recovered very quickly after ATG treatment (reached 0.5+ only a few weeks out of having ATG).
I still noticed that even at the low point after a transfusion (10 days) my mother's platelets are still staying around 20. In previous months they would frequently drop to single digits. Hopefully I am not ascribing meaning to something that ultimately means nothing. Despite having a transfusion threshold of 20 for platelets, they have been giving her a pack even when she is between 20-30, I suppose for precautionary purposes. I would really love to know if the platelets would stay around 20 if transfusions were paused for a little bit. I don't think my mother or the clinic are interested in that, though.
Tapering off of the prednisone seems to be going well still and the drop in cyclosporine seems to have made a small but noticeable difference for her. Swelling has gone down, tremors are still there but slightly lessened. What I think might have been a sign of early cyclosporine toxicity (petechiae unrelated to plt count all over the torso and lower limbs) has cleared up too. When my mother sees the doctor next week hopefully the prednisone can be cut again or dropped.
I hope that they will check the iron and ferritin counts again soon to see if the Exjade is being effective or not, as I can see from the weekly blood draws it is affecting my mother's kidneys somewhat (slightly rising creatine and dropping eGFR)
Matthew42,
I am very interested by your theory about hemoglobin dilution and the issues with the PICC line. When they take blood from your mother's PICC, do they still use a flush to pull a syringe of waste blood first before filling the tubes? Have they done an ultrasound to check the PICC for any obstructions? It's amazing how many little things can cause fluctuations in blood counts.
I certainly hope your mother does not need to repeat the ATG or start the rabbit ALG. Giving it time seems to be the best bet for both of our mothers, as long as there is still some small incline to the recovery. My mother's bone marrow cellularity was 20% on diagnosis, but it's strange that the percentage doesn't always correlate with actual peripheral blood counts. Does your mother's doctor want to repeat a bone marrow biopsy soon?
Unrelated (but also semi-related): I had to stop donating platelets for a few months due to developing iron deficiency anemia
Hopefully I can get back to it soon as there has been a critic blood and platelet shortage. (and the Red Cross has been calling me every single day...) Make sure to encourage people you know to donate blood or if they are feeling daring to donate platelets.
Thank you guys again for keeping me company here. If I didn't have this outlet I would be losing my mind.