Wednesday, March 17, 2010

A Turn for the Worse

Things were looking up today and then took a turn for the worse tonight. I am going to try to give you all a quick physiology lesson so that this blog makes sense. Okay, so we all have blood. We have red blood cells, or erythrocytes, and white blood cells, or leukocytes. Red blood cells (rbc) carry oxygen to the whole body, white blood cells (wbc) help fight off infection. The most common type of wbc are neutrophils. They consist of 50-60% of all wbc and are the first responders to infection. The normal range of neutrophil counts is 1500-8000 or 1.5-8.0. When you drop below 1500 you become more prone to infection or "neutropenic" because you are lacking neutrophils. 500 or 0.5 is then becoming severely neutropenic and now immunocompromised. Okay, next is hematocrit. The hematocrit is the measurement of the packed rbc's. As we mentioned before rbc's carry oxygen, so a low hematocrit can cause low oxygen levels and fatigue. There are many different factors in hematocrit levels but a normal range would be from 35-45%. When the Hematocrit (Hct) drops into the low 20's a transfusion is necessary. Next, platelets (PLTS). Platelets are actually fragments of the cells in bone marrow. They are like little spikey ovals that form a plug, or a scab when you bleed. When your PLTS are low, your ability to scab is low, thus, causing more bleeding. PLTS counts need to be between 400,000-150,000 (read like 150-400). Now that we have blood out of the way lets discuss electrolytes for a moment, the two most important being Na+ (sodium) and K+ (potassium). Na+ should be at 137-146 and K+ 3.4-4.7. Now that we have all of that out of the way I will report his first set of "naughty" labs. Like I previously mentioned, things got a little worse tonight. His K+ levels were considered "critically low" at 2.9. The ordered a double dose of a K+ rider to go over a four hour period through his central line. His HCT was 25 slowly creeping toward transfusion levels, PLTS were 187, which is normal (hurray for one normal lab!), and his ANC was 0.5 (500) bordering on severely neutropenic considering him immunocompromised. He had a fever of 38.6 c (101.48 f) which gives an alarm to infection especially now being compromised. I had a few moments of panic but it soon subsided as the nurses, and resident quickly responded to him and within minutes he had Zosyn (antibiotic) running through his line. His feeding was stopped, and more morphine given to help the intense pain in his "gut". His little tummy looks swollen. It is a normal side effect with neutropenia. He is finally asleep, and soundly it may seem. It is so hard to watch my sad sweet little boy go through all of this {crap}. He has had the K+ rider going for a little bit now and his heart rate is FINALLY dropping. It is in the 120's now. It has been since Monday that it has been in the 140-155 range. The morphine is making him talk in his sleep and he apparently, was just petting a dog! PLEASE KEEP PRAYING. We need as much faith and as many prayers as we can to make this go away! At least take the pain away.


  1. Holly, we are praying, and praying, and praying for Spencer. We love him, but not as much as you do, and Heavenly Father loves him even more than that. And He loves you that much, too. He will give you what you need, and what Spencer needs. I wish I could offer more than words, and prayers. We love you.

    Katie Reng

  2. Prayers being said for Spencer and your entire family.

  3. Holly I loved your physiology lesson! Where were you when I needed you in medical school? :) Keep smiling!