Expert: Meir Wetzler <B>M. D.</B> - 6/15/2009

Question
QUESTION: "My twin daughters were diagnosed with infantile ALL when the were 7 weeks old.  Both have followed relevant protocols but unfortunately we lost one of them 10 days after her BMT at 6 months old due to renal failure and VOD. Her sister is 2 years old now and 18 months post BMT and recently has been unwell, lethargic at times, occasional vomiting, intermittent temperatures and eating much less. She is 2 years old but undersized due to chemotherapy.  Her blood results revealed a high platelet count of 465, and a white cell count of 34.00, neutrophils raised to 27.20. Liver function looks normal.  To date no source of viral or bacterial infection has been found and we are due to go back to the hospital next week for full work-up, in the mean time I'm going crazy....any ideas??"


ANSWER: Dear Cathy,
I'm sorry to hear about your daughters. Concerning the elevated white blood cell and platelet counts, those seem to be reactive and the possibility of an infection that will present itself with additional testing is still high. Are there any new medications that your daughter was started on? Also, do you know who the donor was and how well the donor is doing?
Thx, Meir.

---------- FOLLOW-UP ----------

QUESTION: Yes, the donor is one of our children, she is doing well and was an identical match for the girls. One of our sons is also an identical match..(we have 10 children so our chances of a match were good I guess!). The baby has been on no medication for GVHD, or any other post BMT related drugs for over a year.  We have since had a follow up but the heamatologist and oncologist are very puzzled as to what may be going on.  Her right ear was red and is being treated with Keflex for 14 days, an ultrasound revealed a narrowing or partial obstruction of the bowel but the x-rays couldn't confirm this.  The antibiotics did seem to make some initial difference I thought overall but she is still having very flat periods lasting for hours with occasional vomiting and refusal to eat any ideas you may have would be much appreciated!
she is due for a barium this week.  A couple of other things I forgot to mention which may not mean too much is that her tongue is hanging forward an awful lot, she has occasional bouts of pain where she holds the side of her head and screams(only for a few minutes) and she is constipated, probably doesn't mean a lot but thought you should know.
Kindest regards
Cathy

Answer
Dear Cathy,
You are indeed fortunate to such a large family. It seems that her physicians are doing everything to work up her symptoms and laboratory findings and at this point I have very little to add. I wish her and you all the best and if you will have any specific question, please don't hesitate to contact me again.
Thx, Meir.