When Blood Breaks Down by Mikkael A. Sekeres

Author:Mikkael A. Sekeres [Sekeres, Mikkael]
Language: eng
Format: epub
Tags: Leukemia; leukaemia; blood; cancer; bone marrow; hematology-oncology; anemia; hemoglobin; platelet; white blood cell count; acute myeloid leukemia; AML; acute lymphocytic leukemia; ALL; chronic myeloid leukemia; CML; chronic lymphocytic leukemia; CLL; immune system; myeloblasts; blasts; chemotherapy; bone marrow biopsy.
Publisher: MIT Press
Published: 2020-03-27T00:00:00+00:00

Figure 5.2

The general course of events for a patient with acute myeloid leukemia receiving chemotherapy in the hospital.

The Ara-C finishes infusing on Day 8, the bone marrow biopsy to determine if the leukemia persists occurs on Day 14, and most people recover their blood counts by Day 28, with the first signs of that occurring around Day 21. For those, like David, who need a second course of chemotherapy, it is infused from Days 14 to 19, and blood counts often recover between Days 35 and 42. Bacterial infections can strike at any time, while fungal infections are more likely to hit after Day 10. Breakdown of the tissue linings of the mouth and throat from the chemotherapy (a condition called mucositis) occurs in a minority of patients starting around Day 10 or 12, while the same phenomenon can affect the colon around Day 18 (called neutropenic enterocolitis). For people with APL receiving ATRA or arsenic, the risk of differentiation syndrome peaks at Days 7 to 10.17

“He’s Day 27, Day 13 from re-induction chemo,” Becky answered.

“Are his fevers gone? How’s his diarrhea?” I asked. David, lucky guy that he was, had developed both a fungal infection in his lungs and neutropenic enterocolitis following his terrible bouts of vomiting.

“Tmax 37.8”—his maximum temperature in the past 24 hours, in Celsius, where a temperature of 38, or 100.4 degrees Fahrenheit, is considered febrile—“and he’s down to only four or five bowel movements a day. It’s better with the immodium.” At his worst, he had 10 to 12.

I nodded as I charted all of this in his notes on the computer. Then we went into David’s room to see him. He was lying in bed on his side, with the sheets pulled up tight near his head, now bald. The chair by the window was empty. Betty must have gone down to the cafeteria for lunch. He had lost weight, and his cheekbones were more prominent, accentuated by the waxy appearance of his skin. Hard to have much of an appetite on antibiotics and with frequent diarrhea. A bag of packed red blood cells hung on his IV pole, as did IV fluids. I sat down gently at the edge of his bed and lightly placed my hand on his leg.

“David? Hey, sorry to wake you. How are you doing?”

He opened his eyes but wasn’t startled. “Groundhog Day,” he said softly, alluding to the movie in which Bill Murray plays a weatherman who relives the same day over and over again. One day on the leukemia service can be pretty similar to the next.

“Our goal is to make this as boring a stay as possible for you. Busy night?”

David nodded. “Visited the john a bunch of times. Then the nurse hung the platelets around 6 this morning. She said the counts haven’t budged.”

“Not yet, but it’s still early. I’m hoping to see some signs of life in the next week,” I told him.

“God willing,” he said. I glanced up to the wall over his bed, where a new plaque hung, decorated with an image of St.

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