Update on Emily and a primer on ANC

Emily is feeling much better after they were able to control her fever and throwing up last night in the ER. She felt good today and even went and played in the park for a little while. She was sort of on a high from the tylenol and IV fluids and felt much better. This afternoon she took a three hour nap, which was good. But she did wake up with a fever of 100.0, so she's still fighting something. We don't need to be concerned about the fever, unless we get a 101.3 or higher after 4am, if we were to get that after 4am we would have to go back to the hospital and have her cultures taken again and to test her ANC level.

Today I was asked why or how does this ANC level seem to fluctuate so much from day to day? For example it was 510 on Wednesday and then 1570 last night. What is ANC? To remind you it stands for Absolute Neutrophil Count. It is not a White Blood Cell count, but is the concentration of neutrophils in the while blood cell count. ANC equals the Total WBC count multiplied by the total percentage of neutrophils (segs plus bands). So you can have a high White Blood Cell count, but a low ANC, it's rare but it is possible. Emily's Chemotherapy is immuno-suppressive, The 6MP and Methotrexate lower the immune system by suppressing the bone marrow from making things such as White Blood Cells. When any of us gets a virus or bacterial infection, our ANC gets lower, but if you are on Emily's Chemo it can drop to dangerous levels, aka Neutropenia. That is what most likely happened to Emily, she was getting this virus this week and that on top of her Chemo lowered her ANC to 510. Then we reduced the Chemo dosage, as you will remember. So her marrow started to work more efficiently and her ANC levels shot up to 1570. That's still a pretty low level but once you get above 1000 your body can fight off viruses. The BIG worry in all of this is if she were to get something like Strep or something bacterial, and if her anc were lower than 500, you can have real issues, including a high risk of death. That's why she needs to be in a ER within 30 minutes of a fever, when she is neutropenic, so they can start IV anti-biotics immediately. So to finally answer the question, Emily's ANC fluctuates a lot because we are constantly trying to control it's range with the chemo, while dealing with external forces such as virus. ANC is the main diagnostic value for Lymphomas and many types of Leukemia.