Each child develops a unique pattern of blood counts during treatment, and some parents like to track the changes. You can put lab sheets in a binder or enter blood test results into a computer program that shows trends over time. Doctors consider all of the laboratory results before deciding on a course of action. They should be willing to explain their plan so you can better understand what is happening and worry less.

If your child is participating in a clinical trial and you have obtained the entire clinical trial protocol (discussed in Chapter 9, Choosing a Treatment), it will contain a section that clearly outlines the actions that should be taken by the pediatric oncologist if certain changes in blood counts occur. For example, most protocols list each drug and when the dosage should be modified. The following is an example from a protocol for the drug vincristine.

Vincristine

1.5 mg/m² (2 mg maximum) IV push weekly x 4 doses days 0, 7, 14, 21.

Seizures

Hold one dose, then reinstitute.

Severe foot drop, paresis, or ilius

Hold dose(s): when symptoms abate, resume at 1.0 mg/m²; escalate to full dose as tolerated.

Jaw pain

Treat with analgesics; do not modify vincristine dose.

Bilirubin

Withhold if total bilirubin is >1.9 mg/dL.

Administer ½ dose if total bilirubin is 1.5–1.9 mg/dL.