Tuesday, December 8, 2009
Graph Vs. Host Disease
The results of the biopsy are not yet in, but from what all the doctors are saying Mikayla has GVHD (graph vs. host disease). Acute GVHD is graded in 5 steps from 0-IV based on involvement of the skin, liver, and GI tract. Grade 0 indicates no clinical evidence of disease. Grades I-IV are graded functionally. Grade I indicates rash on less than 50% of skin and no gut or liver involvement. Grade II indicates rash covering more than 50% of skin, bilirubin level of 2-3 mg/dL, diarrhea of 10-15 mL/kg/d, or persistent nausea. Grade III or IV indicates generalized erythroderma with bullous formation, bilirubin level of more than 3 mg/dL, or diarrhea of more than 16 mL/kg/d. Mikayla is not spot on in one grade. Her skin is in the grade III catagory, but other symptoms are not there. Her liver and GI are still checking out fine. Grade III also states that nearly 100% of her skin is covered and Mikayla is maybe around 80%. She is on a constant drip of Morphine and other drugs that help stop the process of the GVHD. It is a scary situation. Infection as always is a great concern. If the GVHD stops and infection is avoided we should come out of things ok. If GVHD begins to attack the GI and liver it gets very complicated. We are still in the early stages and trying together with the teams of doctors to grasp what is happening. We have pried as much info as we can from the doctors, but I think that we have to wait on the biopsy to get better answers. Her treatment is very aggressive and should help. The only other cause for this would be that of an allergic reaction to medicine. All though it is the unlikely culprit it is still something that maybe the root of the cause. Mikayla has been a trooper. Even though she is covered in what looks to be 3rd degree burns she is carring on with herself much as she always does.