The Dark Knight Rises, but Don’t Expect Counts To

Steve McKinionUncategorizedLeave a Comment

Harrison is much better after an “oil change” yesterday. The transfusions make all the difference in the world for these kids fighting cancer. Early in his treatment the transfusions were needed because the leukemia had prevented his bone marrow from producing red blood cells. Now they are needed because the chemo kills off the red blood cells.

This is a scanning electron microscope image from normal circulating human blood. One can see red blood cells, several white blood cells including lymphocytes, a monocyte, a neutrophil, and many small disc-shaped platelets. Red cells are nonnucleated and contain hemoglobin, an important protein which contains iron and allows the cell to carry oxygen to other parts of the body. They also carry carbon dioxide away from peripheral tissue to the lungs where it can be exhaled. The infection-fighting white blood cells are classified in two main groups: granular and agranular. All blood cells are formed in the bone marrow. There are two types of agranulocytes: lymphocytes, which fight disease by producing antibodies and thus destroying foreign material, and monocytes. Platelets are tiny cells formed in bone marrow and are necessary for blood clotting. Source: Wikipedia

If you have followed Harrison’s story long you’ve learned more medicine than you ever wanted. Me, too. There are so many terms I’d never heard of that are now common parlance for me. Two of those terms are “neutrophils” and “monocytes.”

Neuts and monos are two types of white blood cells (there are many different types). All white blood cells are part of God’s design for keeping the body healthy and infection-free. Leukemia is a cancer of the white blood cells. Harrison’s leukemia is called “lymphoblastic” because his cancer is in the pre-cursors to lymphocytes, another white blood cell.

Off all the blood counts oncologists are concerned with, the neutrophils and monocytes are most important. Neutrophils are mature infection-fighting cells. When they are low Harrison is susceptible to infection.

Monocytes float around in the body until needed, then become the type call that is needed [amazing, really]. For cancer patients who are neutropenic (have low neuts), the monocytes count in an indication that the bone marrow is responding to replace the kills neutrophils.

Quite simply it works like this: there is an optimal number of neutrophils in the blood of a healthy person. There are a handful of monocytes in the blood just waiting to be called to “service.” When an infection threatens the body, more neuts are needed, so the monocytes step up to the plate. The bone marrow will kick into overdrive producing more monos to fight the infection.

So yesterday Harrison’s neutrophil count was less than 100. His monocyte count? ZERO. Yep, zilch. Nothing. Nada. Not a single monocyte.

What does this mean for Harrison? Don’t look for counts to rise any time soon.

The bone marrow needs to recover from the trauma of chemo and start making monocytes. The monocyte production will indicate neutrophil production. So while we really want to see higher neuts, we first need to see some monos.  When the marrow starts producing monocytes, rising neutrophil counts will follow.

So while the Dark Knight and his box office revenues continue to rise, it will be a few weeks until Harrison’s counts do.

Until then, Harrison will be somewhat of a “bubble boy.” He’s never been this immunocompromised before.

But the fear of infection is just a part of the “new normal” cancer kids and their families face. There is nothing we can do about it. Until cancer research finds another way, the only chance of beating childhood cancer is this barbaric treatment that itself threatens these kids’ lives. Maybe one day we can think of childhood cancer like we think of polio: something our grandparents worried about.

Until then, we pray for God’s mercy.

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