Wednesday, April 28, 2010

Of Blood and things

Hmm, seems like it's time for a bit of an update.

Mom was back at VGH again today for more chemo. Blood work came back showing her red blood cell count (RBC) is at 84, so she'll be receiving another transfusion on Friday when she goes back. Mom will start the final chemo drug for this round on Friday-L-asparaginase, which she will receive every day for 12 days. Since that will fall over Mother's Day, Mom has already started planning a Mother's day party with all of us in the hospital! If there's a party to be had in this whole experience, you can bet my Mom will be planning it! It seems that nothing can slow her down, although some things will make her pretty tired.

Mom took four naps yesterday and was quite tired all day (although likely connected to her low RBC count). Today the occupational therapist came in and met Mom for the first time in the hospital. She talked with Mom about the difference between being tired and fatigued and gave her strategies for tapping into her inner energy reserves.

We have received some questions from you on how exactly Mom's blood count factors into her immunity and her energy. I'd like to explain a little about how that all works. I'll try to use lay-men's terms.

Your blood is made up of "formed elements" and fluid.

The fluid, called plasma, makes up 55% of blood and is mostly water with other solutes dissolved in it.
The "formed elements" are 45% of blood. Mostly Red Blood Cells (RBC's), the formed elements also contain White Blood Cells (WBC's) and platelets.

Everyone knows about RBC's, they have a big protein called hemoglobin that carries oxygen. RBC's are important because they carry oxygen to all the cells and exchange it for carbon dioxide thereby feeding your body's cells so they can carry out their functions.

Platelets are what forms the scab you get when you scratch yourself. If you break a blood vessel the platelets are 'activated' and start to form a wall that blocks blood flow out of the blood vessel. This is the scab you see that covers the original wound.

WBC's are the infection fighters. There are five different types of WBC's: Neutrophils, Monocytes, Lymphocytes, Eosinophils, and Basophils. Neutrophils are the most numerous and along with Monocytes and Lymphocytes are responsible for the majority of the "battle" against invading pathogens to the body. A pathogen is basically anything that is foreign to the body whether it is a germ (bacteria or virus) or a dust particle, or even transplanted tissue. Eosinophils and Basophils are kind of like the cleaners, they come in after the other three WBC's have done their job and clean up. Basophils are also responsible for releasing a chemical involved in that wonderful thing called allergic reaction. The next time you're sneezing and coughing from seasonal allergies you know who to blame!

Of the fighters, Neutrophils and Monocytes work basically the same way, they see something foreign and they eat it. Chemicals inside the cell then break it down and destroy it.
Lymphocytes work a bit differently, they are more specific. Lymphocytes make antibodies which recognize a particular component of the invading pathogen. The antibodies then bind to that component, thereby disabling the pathogen.

But where do all these blood cells come from? I thought you'd never ask. Blood cells are formed in your bone marrow from stem cells. You may be aware of all the debate over stem cells in the last few years. I won't get into the debate now, but if you've heard of it you're aware that stem cells are very amazing things. Your body is made of millions of cells. These cells are constantly dying off, which isn't a problem because they are able to replace themselves. Divide and conquer! Your cells have the ability to divide, so where once there was one, now there is two! But each cell can only make a duplicate of itself, it can not make any other cell. This is important because there are thousands of different kinds of cells in your body. Enter stem cells, a stem cell is called such because it has the ability to become different types of cells! Stem cells in your bone marrow divide to make nine different types of blood cells.
Two stem cells arise from the first division of the stem cell in bone marrow. The first stem cell is able to make RBC's, platelets, and most WBC's. The other stem cell specializes to make the WBC the Lymphocyte. I mention this because it is from these stem cells that Mom's type of Leukemia arises. Acute Lymphoblastic Leukemia is a cancer of the cells in the phase of division between the lymphoid stem cell and the final product, the lymphocytes. These cells are called Lymphoblasts, hence the name of Lymphoblastic Leukemia, and Acute, means that it develops fast (as opposed to Chronic).

How does this relate to us, you ask? Let me tell you. The Leukemia developed in Mom's bone marrow, as the cancer cells grew they plugged up the portal that the blood cells would have used to exit into the blood stream. This is what caused Mom's anemia that initially put her in the hospital and led the doctors to discover her Leukemia. Now that Mom has started chemotherapy, the drugs she is being given are killing the leukemia cells. But because Mom's WBC's look almost identical to the cancer cells, the chemotherapy kills them too. This is what has caused Mom's WBC count to drop. It is also somehow connected to Mom's RBC count, but I haven't worked that all out yet.

In lay-men's terms, chemotherapy causes the destruction of Mom's blood cells. As her RBC count drops Mom becomes tired because her body's cells aren't getting the oxygen they need to function. This is when Mom gets a blood transfusion. Her WBC's are responsible for all of Mom's immunity. If her WBC count is low (which it is right now) Mom has to be very careful to not expose herself to germs. This means that she is not able to go out in public places where she will be in contact with a lot of people because her body has no way of protecting itself from the normal everyday bugs we all carry around with us. And of course, as we have mentioned lots on this blog, it also means she is not able to see anyone who is sick, for the same reason that she can not fight off the germs that she would encounter.

You may not realize how many germs your body comes into contact with everyday because whenever a germ enters your body your WBC's come along and destroy it. You get sick when a germ has the ability to multiply and make itself at home in your body faster than your WBC's can destroy it. For Mom, and other chemo patients who have no immune system, any germ that comes into their body will be able to multiply like crazy. As the germs grow they use all your body's resources, like oxygen and sugar and water. All the things your body's cells need to survive. Well, if the germs are taking all those nice nutrients, than your body's cells are left with nothing. It only makes sense that things die when they are starving. Of course all of this takes place on a microscopic level and we only begin to appreciate it when it has a large enough effect to be visible at the bigger level.

Well, let's step out of the microscopic world of blood and it's origins and come back to the everyday world of people. I hope you understand a little better how Leukemia works and how all this talk about blood counts effects Mom and what she is able to do. If you know anything that would bring more clarity to this post, please feel free to share.

Thanks for reading, praying, caring and walking with us!



  1. I loved your explanation Amy! I havew forgotten all my Bio.12 except how to say those terms. I am so proud of your 3 lovely daughters. The road you walk is difficult, but you are being authentic and faithful as God enables you. You will be blessed in unexpected ways. love to you all, "auntie" Ingrid

  2. I love that you are putting all your nursing stuff to good use Ames! You might have to describe what "solutes" are for those who haven't taken high school chemistry recently. :)
    Give your mom a big hug for me if you can - and one for each of you as well. I have something special planned (At a distance of course), will be sending it soon!