The goals for today were to wean what could be turned down and keep stable what was needed to provide stability going into the granulocyte transfusion (the goal is to get the neutrophils which are a subcategory of the broader white blood cell group: granulocytes)
This morning they turned off her milrinone; everything has remained stable
Her abdominal pressure seems to be going down a bit as well as her abdominal girth
In order to get in a more complete dose of her TPN, they increased her fluid limits slightly and she has tolerated it well with an appropriate increase in urine output. This means her kidneys are keeping up beautifully
Her morphine has been reduced by half and she has done well with that
The big news of the day is that she began pooping which is really pretty great since it’s the first time in 5 days. She’s had quite a bit of abdominal discomfort and cramping just prior to each time. While it’s unenjoyable for her, we are encouraged that things are moving again
At long last, the neutrophils/granulocytes finally arrived about 7pm. They gave her Benadryl ahead of time to ward off any transfusion reactions and are running them over four hours. We’re over halfway in to the transfusion and there is no sign of a reaction which is great. Once the neutrophils enter her system, they will travel to the locations they are needed and begin their work. I honestly don’t know how long before one might see a response to their activity, but the docs are prepared to support her with whatever occurs. I found out today that it is quite an immense undertaking for the donor to donate granulocytes and for this reason, they are only called upon to give those who are neutropenic (without neutrophils) and have a very serious illness. Thank you to those brave and giving folks out there who are willing to so tangibly give of themselves for the wellbeing of a stranger.
It was overall a good day with a number of great steps forward. She is still far from her normal, cheery self but her fluid load seems to be diminishing and she is slowly regaining some movement. She sat upright for the first time in days (with assistance).
Tomorrow we hope to see more steps forward but realistically, she is doing phenomenally well and the staff is impressed with how great she is handling everything and are encouraged, we have much to be thankful for as things stand.