Why is Mathew’s blood tested twice weekly and what are we checking?

Excellent question!

There are two pages of tests run every time blood is drawn but for us non-medical and untrained unprofessionals (aka the parents!) we check four levels from the Complete Blood Count (CBC).

First, we need to know that blood cells are fast-growing. These blood cells come from the large bones of the body. More precisely, they are made in the bone marrow (middle of the bone) of the pelvis, the breastbone and the long leg bones. Each cell starts out as a stem cell then grows into one of 3 major types of cell, depending on what the body needs.

Second, we need to know that chemotherapy kills fast-growing cells such as the blood cells.

Third, we need to know that the three types of cells manufactured in the bone marrow are red blood cells, white blood cells (also known as a leukocytes) and platelets.

From the three types of cells we check four levels: hemoglobin, leukocyte (& related neutrophil) and platelet levels. The results give us a snapshot of how Mathew’s body is responding to the chemotherapy.

The first type of cell, red blood cell, has hemoglobin (Hgb) in it which carries oxygen from the lungs to the body. When the hemoglobin is low Mathew feels tired or has breathlessness/trouble breathing. If the count falls below 80 (normal is 130 – 170) then Mathew gets a blood transfusion – he has received 2 in the last month.

The second type of cell, white blood cell (Leukocyte (LKC)), fights infection in the body. A healthy human’s blood consists of 1% white blood cells. Please note that white blood cells and leukocytes are interchangeable and mean the same thing; the leukocytes are measured and also one particular type of white blood cell: the Neutrophil (Neuts). The neutrophils make up about 50-70% of the white blood cells and it indicates ability to fight off infection (pus is created when high numbers of neutrophils die off when fighting infection).

A normal leukocyte range is 3.5 – 11.0. A low count is known as leukopenia and means the body’s disease fighting cells are too low.

The normal range for neutrophils is 2.0 – 7.0. A count of less than 1.0 is known as neutropenia, where Mathew is susceptible to infections because he has no natural immunity (if the count falls below 0.5 then normal bacteria in Mathew’s mouth and digestive tract can cause infections). At a level below 1.0 Mathew’s chemo is delayed or cancelled. Twenty-four hours after Mathew finishes the chemotherapy drugs he starts his daily shot of neupogen until the day before the next chemo treatment. Neupogen stimulates the growth of neutrophils. This drug is approximately $4,000/month in Canada and it is an injection given just under the skin in the fatty part of the arm.

The third and final type of cell is the Platelet. Platelets are tiny particles that help your blood to clot. If these are too low then you can bruise or bleed easily. Normal counts range between 150-450 and a count lower than 20 becomes a serious concern.

When I post “No Visitors” or we tell you the same thing, it means that Mathew can’t have visitors because his white blood cell count or Neutrophil count is too low (You can still visit John and I!). When they are low he is in danger of contracting something that will put him in the hospital. If at any time he gets a fever of 38 degrees Celsius or above we are to take him immediately to the Saint John Regional Hospital and present the ER with the special yellow card that details Mathew’s care. He is classed as Category II Triage and is considered a “MEDICAL EMERGENCY”.

Here are test results from the past 1-1/2 months:

…………………..(3.5-11.0)      (2.0-7.7)      (130-170)     (150-450)
Date            Leukocytes    Neutrophils    Hemoglobin    Platelets

26 Sep 13          8.5               5.68              104              122
29 Sep 13         26.4             21.38               97              235
14 Oct 13         13.1               9.82               90              117
21 Oct 13           0.4               0.20               80              149
24 Oct 13                               0.30
04 Nov 13          1.6                1.5                77              212
07 Nov 13          0.3                 0                  89                76
11 Nov 13          4.7                3.06              88                35

The spike in levels on the 29 Sep 13 results came from the neupogen injections early in the treatment ~ the chemo had just started.