20 Million Cells Delivered!

Monday I went through apherisis. It means processing my blood through a centrifuge and taking out the layer that contains blood stem cells. The goal of the team is to pass the entire five liter volume of my body’s blood through the machine about four times -- or in other words to reach a goal of twenty liters. The goal for cell collection is twelve million. That is enough for two transplants plus a buffer of two million.

The day started early. HUMC is an hour north of home, so I left at six-thirty allowing for rush hour traffic. My appointment was at eight o'clock. After the usual height, weight, blood pressure, temperature and pulse rate checks, I went in to the labs where one of the regular vampires nabbed breakfast snack of two or three tubes. Well, okay: They needed a baseline to know my condition before starting.

When the results came back, it was clear that I was in good shape. My white blood cell count was over sixty two thousand. I was told that I would be finally released from treatment after the transplant when I returned to ten thousand. Sixty two is a very good level.

Then they sent me to the Apherisis room. There was a LOT of paperwork to process: consent forms, treatment plans, prescriptions, doctor's orders, protocols, Health Information Patient Privacy Act - HIPPA release forms, and even more. There was a blizzard of paper moving around that small four bed/apherisis machine procedure room. But since I was first, most of the two nurses’ attention was on me.

Each bed had its own pumping station. The pumping station itself is about the size of small desk. The top part has poles with arms held straight up for holding intravenous bags. Clear plastic bags held plain water (saline solution) and another with blood thinner. They didn't want to risk clogging their fancy machine with my muddy blood. The front of the box was decorated with dials having various markings and the face panel had colored stripes with arrows illustrating the flow pattern. Then clear tubing ran through clamps into the rollers above the stripes and there was a fancy two way in/out connector at the end for me. It looked fairly complicated, but it also looked kind of primitive. It had painted words next to the colored lines telling the user which tubes to put where and some clear warnings too. It made me wonder how much training was required before a person was allowed to operate it – if so much instruction had to be painted on the front of the thing. No matter – by ten o'clock I was hooked up and I could see my blood flowing through the tubing.

Everything was hunky-dorey until we found out my catheter was temperamental. They said it was ‘positional’ and I interrupted the flow every time I moved, or breathed! Every time I took a deep breath the machine lost flow, an alarm sounded and the pumps stopped. So moving and breathing were going to have to be stopped! When the director of Apherisis came to check up on progress, one nurse told her, “Mr. Kirk is ‘positional’.” It came out like a slur on my character. So I worked harder to maintain my special position – lying still, flat on my back with my head as far left as I could manage to hold it, breathing shallow. Fortunately, each bed has a mini television on a very easy to position jointed arm that allowed me to lower the set to eye level. I got an ear plug so as not to disturb others.

The nurses, thank goodness, had no earplug because they had to listen for the alarm then run over every time I forgot my restrictions and took a deep breath. How Could I Be So Stupid?!? OH! MY! GOODNESS!

Actually it was really quite a hassle because it happened thirty or forty times. Fortunately, the two nurses quite understood and took it in stride. It was not just an inconvenience to the nurses. It was an interruption in the flow and did stop progress of the collection. After four hours we had reached just seventy five percent of the volume goal. Only fifteen liters had been processed. By then, it was already two o’clock in the afternoon. Other patients needed the bed and the machine, so I was disconnected. I was, after all, expected to be coming for as long as five days if the collection needed that long. However, I was not looking forward to attempting to lay nearly motionless, keeping my breathing shallow and being able to little else but watch daytime television for even one more day! Too bad – my desires had little to do with anything. We needed to collect at least twelve million blood stem cells for my treatment to proceed.

So after I got disconnected, a few tubes of my blood were sent off to the lab to determine how well I had fared on a physiological level. They showed I had a white blood cell count of forty two thousand. That was nearly a third lower and definitely a lower level of resistance against infection. Still, I felt fine and I started hoping I would manage a full twenty liters on Tuesday. Then they sent me home.

My entire collection (you may be curious to know that the actual volume of blood they took away was just about 220 ml – about half the volume a regular blood donor gives when they donate whole blood) would be sent to the lab for evaluation and an estimate of the progress toward the goal of twelve million blood stem cells would be done overnight. I went home a bit frustrated, but satisfied that the process had begun. Results would be known before we started the next morning.

When I returned the next morning, I had to get weighed, measured and do blood tests to check my starting levels. Then I sat and waited in the lounge for the nurses to arrive. After about twenty minutes, the friendly folks at reception caught my attention and whispered, “You are done! You collected twenty million yesterday. You can go home!”

WOW!

After all that trouble just to deliver seventy five percent of the volume, the collection came in nearly double the goal! I am really proud that my body was in good enough condition to produce so well. And I did not have to endure another day of that process!

Coming Attractions
The next phase starts the 7th of February. That is the day I go back to HUMC for the transplant. That means one day of chemo -- the death of my bone marrow, then the "Rescue" --the return of five million of my own blood stem cells one day after the chemo. Then we watch my white blood cell counts every day. Somewhere between days six and eight, my counts will drop. They will continue dropping as cells that were adult on the day of chemo finish their normal life span. My counts may approach zero and I will have lower and lower resistance to infection. Without having received the Rescue, my immune system would be permanently disabled. As the numbers are reported, we watch for signs that the transplanted cells have 'engrafted' and are living normal lives. That is signaled by a rise in white blood cell counts. Once I return to at least ten thousand they will send me home. Though risk of infection will be very real, the 'standard of care' has resulted in the best recovery results when the patient is at home.

... and I guess that's all I know about that