On Day +14, September 30, 2014, Todd's CBC blood counts were:
Hemoglobin: 7.8, White Blood Count: 70, and Platelets: 8,000. Technically, he needed a platelet transfusion since his platelet count was under 10,000 and a blood transfusion since his Hemoglobin was below 8.
Unfortunately, the Red Cross Blood Bank located within the Cleveland Clinic denied Todd platelets because of the platelet shortage they are experiencing. (Did did receive a blood transfusion). I was upset by this news and asked the doctor on call to come by his room to discuss this me.
First, let me say that the doctors here are great advocates for their patients and argue our case for whatever they need to the blood bank.
Q. I asked him why they denied him platelets?
A. His response: They denied him based on the concern that they have been giving him platelets daily, but that he wasn't retaining them. In light of the shortage, they felt they didn't have enough to spare if his body was going to remove them and/or his body wasn't retaining them.
Q. I asked about using the HLA matched platelets that he had requested?
A. Apparently, they still were not able to provide them.
Q. Next, I asked if I could donate blood for platelets or if his brother, who was the bone marrow donor, could give blood/platelets that way?
A. He said that this was not easy to do because it is very cost prohibitive and that there are too many clerical errors made in labeling and getting the donated blood to the correct patient.
Q. I asked him how low did his platelets have to drop for it to be critical if he didn't get a transfusion?
A. His response: He stated that there was no set number they had to drop to where the Blood bank could no longer deny him platelets. He explained that Todd's body would eventually be able to make and retain his own platelets once the new bone marrow is more engrafted. The decision is based on their own judgment.
The next day, Day +15, Wednesday, October 1, 2014, a new doctor was on rotation. Todd's CBC was HBG: 8.5 (so no blood transfusion was needed) and his white count finally hit triple digits: 130, but his platelets were down to 6,000. There was talk about giving him the HLA platelets, but not until next Monday, October 6. I'm not sure the reasoning, either they felt he would be in a better place to keep them then or that they wouldn't be able to get them until them. We were surprised when his nurse came in late in the morning saying he was getting regular platelets that day. We asked what had changed, but she didn't know. The doctor on rotation came in and explained that as the advocate for the patient, they argued again and did testing to prove that Todd's body was not creating any anti-bodies that was killing the infused platelets (This can happen because the body thinks that the platelets are a foreign invader and try to kill them). Since the blood bank had this proof and reassurance, they were more receptive to the request for platelets.
Yesterday's transfusion must have worked, his platelets went from 6,000 to 9,000 today (Day +16) October 2, 2014. His white count jumped to 300! But his Hemoglobin was down only slightly at 7.9, which meant he needed both platelets and blood today, but thanks to the great doctors on staff here and the tests they did, he received both with no problems. We are hoping the white count will start doubling at this point. This gives him greater immunity to infections.
We are all hoping to be released from the hospital one day next week, October 6-10th, Days +20-+24. While this are the number of days since the transplant, we have actually been at the Cleveland Clinic for 25 days already.
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