January 15, 2012

Now we've got things moving.  All of the cultures from Friday night and the new ones from yesterday have come back negative, so we started the pheresis around 10:25 this morning.  There was a good bit of prepping beforehand.  We had to get baselines for all of his vitals as well as calcium levels.  The nurse will draw blood every hour throughout the process to make sure that his levels on that end all look good.  He was also pre-medicated with Benadryl and Tylenol just like you do with a transfusion.  Then the lady doing the procedure came rolling in with her machine (she has been here since 1994 and has been doing this procedure, with this machine, since one of the doctors first implemented it; she is the best of the best).

So once she got set up, we helped them hook up his "vascath" (line used for procedure we had put in on Friday).  The line has two lumens.  One pulls his blood from him and the other returns his blood once it has been processed.

As the machine pulls the blood from him, it circulates it through it's intricate system and then into a centrifuge that then spins it to separate the different cells based on their weights.  The cells we are collecting then collect into a bag.  During the entire process, there will be a steady and equal flow of blood both in and out of him.  The machine was primed with a mix of transfusion blood and saline to give him in the first few minutes, until the process reached the point in which his own blood is returned to him.

The empty bag on the left is where the cells we harvest will be collected.

The entire process will take at least 4 hours (only once has the nurse seen it take less).  It typically takes from 4-6 hours, but it can sometimes take until midnight.  So far we have had no problems, which is a very good sign.  Clayton has been asleep since before the procedure started and is sleeping peacefully still.  The machine has a humming/sshhh sound much like his noisemaker he sleeps with at home, so it should be soothing to him.

The machine harvests in stages, and we got our first harvest while I was writing this!  This is amazing, the cells in this bag are the cells that will give my child his best hope at a prolonged life with the least risk of relapse.  These are VERY important and VERY valuable little suckers.

After 1 harvest

After 3 harvests

**Beware, the following is a bit of a science lesson**

Here is the scoop about what we're harvesting: We are harvesting his CD34 cells.  These are the strongest white blood cells he has.  These are the bad boys he will get back in the transplant and use to build back his immune system.  I am not sure exactly how many we are trying to harvest, I have heard 15 million with some of my research, however it is common to collect 30 million and even 50 million.  The more the better.  Any extra cells collected will be stored for at least five years in case he ever needs them again.  As you can imagine in order to harvest that many of these cells his counts have to be extremely high.  I can get the point across with just his white blood cells so I'll use them.  A normal white blood count (WBC) is 5.50-15.50.  When Clayton is neurtopenic his is around 0.1.  We had to wait for them to come up so we watched them rise from 0.1 to 0.22 to 0.55 to 7 (they can jump fast).  His white blood count is used to calculate his ANC.  When his ANC reached a 1000, then we began giving him a double dose of neupogen (a drug that stimulates the growth of WBC) in order to get as many WBC as possible.  So yesterday his WBC were 20.49 and today they were 38.95.  As you can see they are well above the normal range, but that is what we needed for harvesting.  Good stuff, huh?

**I believe that concludes today's science lesson**

Anyhow, the doctor has been in to check on things and the process seems to be going well.  We have had multiple harvests now and the technician doing the procedure estimated that based on our progress so far, we may be doing this until 3:30 or so.  We should know around 5ish how many cells we collected and if we have to try it again tomorrow.  They will also do cultures on the cells that have been collected to ensure that they are cancer free and free of any bacterias as well(not sure when we'll know those results).  I'll update everyone later.  For now, he is still sleeping peacefully...blissfully unaware of the awesome process that will do so much for him later on...

I hope this helps everyone feels connected.  I know some people like to know more details than others and so I try to give as many of the details as I can.