[Lisa V]

Laurie, those are low counts, but they're not that unusual for SAA. Plenty of people have come back from worse counts than that, and the body also has a remarkable ability to adapt to lower counts over time.

If they're giving him ATG they must have done a BMB (bone marrow biopsy) to confirm AA. Are they also transfusing him? The usual target number for platelet transfusions is 10k or below, and for RBC it's Hgb of 8.0 or lower, so it sounds like he could use some of both ASAP. ATG is hard on platelets, so it's not unusual that his Plt count would drop during the treatment. My husband has had 2 ATGs and during his last one he was getting almost daily Plt txs. Once the ATG was over it didn't drop nearly so quickly and once the ATG started to kick in they started coming up again, but it can take a while to see a response.

The vancomycin is for a fungal infection, possibly Clostridium or something like that. Do you know what his ANC (absolute neutrophil count) is? Neutrophils are the infection-fighting WBCs. This may be listed on the CBC as 2 separate figures: segmented neutrophils and bands, which added together give the ANC. Or sometimes it's given as a percentage that you multiply with the overall WBC to get the ANC. An ANC of less than 0.5 is considered severe neutropenia, and may necessitate strong protective measures such as not eating any unpeeled fruits or vegetables, wearing a face mask, avoiding physical contact with other people, etc. I'm guessing that with an overall WBC of 0.4 his ANC is going to be pretty low. Has anyone discussed giving him Neupogen or some other form of G-CSF shots? This can help him boost his neutrophil production. WBCs are not routinely transfused the way RBCs and Plts are, because they are extremely short-lived. It can be done in emergencies, but G-CSF (granulocyte-colony stimulating factor) shots are more often used.

I know this is all very overwhelming, but many of us have been there, or our loved ones have, and there is hope! Please feel free to ask any questions that come to mind. We don't all have the option of going to a hospital with an AA specialist. If you can, then do it, but if you can't, then the best thing you can do is learn as much as possible about the disease and become an active participant in your father's care. Ask the doctors hard questions (without being combative) and keep them on their toes. Patients who are proactive in their own treatment, or who have a family member or friend who can act as their advocate, will recieve the best care.

For what it's worth, ATG is the most generally accepted course of treatment for people over age 40, or younger patients without a good match, so it sounds as though he's on his way. It can take months to kick in though, so try to be patient.