[Lisa V]

Lamilu, chills and fever are absolutely normal for the first infusion of ATG. It is not an indicator that anything is going wrong, it's just a serum reaction which usually passes after a few hours. I don't know of anyone who has NOT had this reaction, but sometimes an inexperienced medical team can mistake it for symptoms of infection and administer antibiotics (this happened to us). Hopefully they will not do that with your mother unless they have some concrete evidence something else is going on. Normally they just give Tylenol and wait it out.

Hives indicates an allergic reaction, so slowing down the rate and increasing the Benadryl are also standard procedure. Whether or not she will be able to continue will depend on how severe her reactions to the ATG become. This is something for the doctors to determine, but she may have to tolerate a certain amount of discomfort for a while.

Hyposplenism is not sepsis, it is reduced spleen function. I don't know a lot about the spleen, but I found this quote from Williams Hematology:

"The spleen culls aged and abnormal cells from the blood; removes intraerythrocytic inclusions through a process called pitting; sequesters approximately one third of the normal intravascular platelet pool; removes bacteria, foreign particles, and tumor cells from the blood; and by virtue of the T and B lymphocytes and macrophages in the white pulp plays a role in immune surveillance and antibody formation. Exaggeration or impairment of some or all of these splenic functions results in hypersplenism or hyposplenism, respectively."

So basically, since the spleen appears to play an important role in filtering out impurities from the blood, a loss of function could put one at an increased risk for infections. That does not mean that sepsis is the inevitable result, it just means that her immune system is compromised, which you already know. In fact, if it's only the T and B lymphocyte function that is being affected, that may be kind of a non-issue at this point because those are what the ATG is intended to knock out anyway (in order to short-circuit the autoimmune attack that is thought to be causing the AA in the first place). What is more important at this point is that she has enough working neutrophils to take up the slack, but as Marlene has stated, it is still possible to go quite a while without them, so long as she is being monitored and managed for any flare-up of infection.

Just judging by the quote above, it doesn't sound as if her spleen function would have any impact on neutrophil production. It may be affecting her platelet production, but I'm not sure exactly how. Just to put things into perspective, though-- in the old days before ATG and BMTs, the first line of tratment for AA was removal of the spleen. I don't think it was terribly effective in a lot of cases, but they certainly wouldn't have done that if you couldn't exist without a spleen. At any rate, we are fortunate to have better options these days.

Hope this helps some,