The Purple Meanies

 

What we're looking at here (if you couldn't figure it out from the labels) is normal bone marrow versus leukemic bone marrow.  Sorry about the crappy photograph of a photocopy; our scanner is beyond my technological abilities.  And it humiliates me to have to ask my 14 year-old to explain it - again.

I'll try to explain this to the best of my ability; please try and remember that all of my medical training has come from watching ER and House.

Top left:  This is normal bone marrow.  The pink circles are red blood cells. The purple ones are immature red and white blood cells, as well as the differentiated mature white blood cells.  They have been stained by the pathologist.  (Fact:  immature blood cells are larger than their adult counterparts.)

Top right:  This is a smear of normal bone marrow.  The big white areas are just air bubbles on the slide.  (I'm assuming.)  Again, the red/pink circles are red blood cells.  The purples are immature RBCs and and the various WBCs.  Hard to tell, but there are a bunch of different shapes and sizes.  In this healthy bone marrow, only 5 percent of the total cells are immature WBCs, or blasts.

Bottom left:  The purple blobs this time are leukemic blasts.  They are WBCs that remain immature, multiply continuously, and provide no defense against infection. 

Bottom right:  Again, the purples are leukemic blasts.  A diagnosis of leukemia can be made if more than 25 percent of the blood cells in the marrow are blasts.  When these blasts multiply without check, they fill the marrow, preventing the production of healthy RBCs, platelets, and WBCs.

The bottom pictures are of Maggie's marrow at diagnosis.  It's the most gut-wrenching feeling to find out that what you think are textbook pictures are actually pictures of your daughter's normal bodily processes gone awry.

Pretty indisputable proof that Maggie is sick, but I find that I'm still having trouble accepting that she really, truly is.  From what I've read, there are a number of typical emotional responses experienced by parents - much like those in the grieving process.  It's not so much a smooth evolution from confusion to hope, as it is a wild vacillation from one feeling to another.  So far, I seem to be spending an awful lot of my time in denial.  Aside from her swollen lymph nodes, Mags wasn't exhibiting any of the typical leukemia symptoms; she only really started looking and feeling sick after we began treatment.  Could we have made a mistake?  Are we unnecessarily bombarding her body with medications, and then more medications to counteract the harsh effects of the first medications?

I know. <sigh> I know.