December 8 – A Fever

On this Day 8 of post-transplant, Dennis has acquired a fever. His blood has been drawn from the PICC line and was sent to the lab for cultures. Additional blood was drawn from one of his veins so that an infected PICC line can be ruled out. We will know the results of the tests after any bacterium present has a chance to grow         (+/- 24-hours).  Also, four chest x-ray views were ordered to be certain there is no pneumonia or other inflammation of his lungs present.

Stem cells travel to the bone marrow where they will stay and begin to produce the body’s blood cells – red and white – in a process called engraftment. The process can take 2-4 weeks; but full reestablishment of the immune system can take several months. I can only speak in averages, but have been advised that the average transplant patient can be released from the hospital when the white blood cells or (WBC, Immunity cells) reach a level of “above 2”.  But, each doctor determines the patient's release based on the various individual factors of each patient.

	Dennis’ Current Levels	Ideal, or “Normal” Levels
WBC (White blood cells / Immunity)	< 0.1	3.5 – 10.6
RBC (Red blood cells / Hemoglobin)	9.9	13.3 – 17.1
Platelets - in thousands (Stimulate clotting)	25	150 - 450

Potential causes of this fever:

• We are told that a common complication during engraftment is toxicity from the preservative protecting the stem cells during the freezing process.

• Another, and potentially dangerous, complication during engraftment is the increased risk of infection with bacteria, fungi, and viruses as the body’s white blood cells are trying to build to normal levels. 

Dennis has been consistently receiving antibiotics in tablet form each morning, to prevent some of the more common and dangerous infections, since the transplant. The doctor has ordered an additional IV antibiotic, which will continue being administered throughout the next several days. 

I am less than bored.  Just in time, too - there are no prisoners to keep an eye on at the moment.

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