A quick hitter today: It’s day 24 of round 5 (Intensification 3). Noah’s doing okay, but having a rough go of it today.
Not unexpectedly, hemoglobin and platelets have continued to drop. Yesterday morning he got a third transfusion of platelets and first red blood cell transfusion of the round. ANC has been effectively zero for 10 days now.
He had good energy and felt okay most of the last week, but started to get a headache yesterday. This morning the headache got worse and then he vomited. He had no fever and no symptoms suggesting a specific cause. One concern with low platelets and lack of obvious symptoms is for intracranial bleeding. A thunderclap headache, vision changes, and/or balance and coordination problems tend to appear in those cases though and that does not seem present.
A few hours later he spiked a fever, which more likely points to something viral or bacterial. He immediately got a “poke” again for blood cultures and was put on cefepime and vancomycin, the two heavy-hitter antibiotics. He vomited again an hour later and has just been resting and not really eating or drinking. As of now his fever has crept all the way up to 104, which is getting up there.
We’ll have to wait on the cultures. He got a rapid test and doesn’t have the flu or covid. We also can’t rule out this being part of count recovery as he has spiked fevers during that part of each round. As mentioned his ANC has been effectively zero, but that’s just the neutrophil component of white blood cells. Often a precursor to ANC is APC, which also includes monocytes. That’s also been absolute zero for about a week, but today a few monocytes were detected amongst his white blood cells. It’s possible that system is firing up but, if it is, we’d like to see it a little less hot.
They’ll continue to monitor more closely here, check cultures, and keep the fever under control. I’ll try not to leave you hanging and will post an update within the next few days. We love you all and over and out.