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 in 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 5, Choosing a Treatment), it will contain a section that clearly outlines the actions that should be taken by the neuro-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.