Sorry for the delay but we had to clear things up with the docs this morning and then I had an exam to take this afternoon. My dad was discharged this morning after a night in the ER. His hemoglobin was 6.6 which is getting pretty low. Between 14-18 is normal for an adult male. When you start getting 10-12 it gets into the mild range, but nothing to worry about. Dip down to 8-9 and the doc may prescribe a unit of blood if you're symptomatic (out of breath, fatigued, easily tired, etc). Below 8 and now you're critical. Start getting down into the 4-5 range and you start running all sorts of risks for complications like heart failure. He got 2 units of blood last night so that takes care of any potential acute crisis for the next week. That's the good news.
Now the bad news. His hemoglobin went from 11.5 to 6.6 in just a matter of ~18 days. That's pretty quick considering the lifespan of a red blood cell is 3-4 months. If he's losing that many red blood cells in just over two weeks then that means new red blood cells are not being produced in anywhere near sufficient quantity to replace those being lost. He can't keep up with the turnover. I hate to pile on but his neutrophils (a type of white blood cell that's a first responder to bacterial and viral invaders) went lower yet. Anything north of 1,700 is normal, preferably 3,000-6,000. His have dipped down to just 420 which makes him very susceptible to opportunistic infections. So not only is he susceptible to the flu and such, but he's also suspcetible to normal bacteria that live in the nose or mouth but are kept in check by a normal immune system. Those normally harmless bacteria could potentially become very harmful in a compromised patient like my dad. And the platelets (the cells that form clots when you're cut) are hanging around in the very low numbers, too, which puts him at risk for potential bleeds. Add an acutely enlarged and inflamed spleen to the mix and all these point to a volcano that's starting to rumble and is getting ready to erupt.......His disease is progressing........He was given an antibiotic prophylactically and a steroid to reduce the inflammation around the spleen and reduce the pain associated with it. So while an acute anemic crisis was avoided (thankfully!), looking further down the road shows his disease is starting to act out in ways that are not good. He has an appointment with his leukemia oncologist on Wednesday to decide with which treatment to progress.
Some may be wondering, why did it take so long to start treatment if his disease is progressing? It's a valid question. Let me first start off the answer by stating that the practice of medicine is both a science as well as an art. There are biological truths, half truths and just plain suspicions. Put those together with every patient being unique and you're left with art and intuition playing a very heavy role. Keep in mind, my dad had multiple crushed vertebrae in his back. That's nothing to sneeze at. If he did not get those addressed, he'd be in severe, and I mean SEVERE pain. Chemotherapy would take half a year and would preclude any surgical intervention for his back for at least that long, if not longer. I don't think it humane to subject him to that kind of pain for that long unless absolutely necessary. So the doctor made a decision on a patient who at that time had stable blood counts over repeated measurements and desperately needed to address the pain in his back. He decided to have the patient get the back taken care of, recover 2-4 weeks (it's been 3) and then let's start whatever treatment we're going to use (chemo vs. stem cell therapy). I don't second guess the doc one second on that decision and despite the acute near crisis, I still think it was the right decision. If we had to do it all over again, I'd make the same decision without hesitation. I realize that may be of little consolation to my dad who feels like crap right now. But it's not a perfect clear cut path that is laid out. We'll know more by the second half of the coming week.