Help Jervyna Fight against Acute Promyelocytic Leukemia (APL)

Jervyna Pascual San Jose a 5 year old girl from Rizal, Philippines, diagnosed with Acute Promyelocytic Leukemia, a rare sub type of Acute Myeloid Leukemia, only 5-10% of AML got it, but it is the only sub-type of AML that has good prognosis.

Early weeks of July 2021,

Jervyna complaint about aching stomach and aching while urinating, which triggered us to visit nearby Pedia (Dr. Bentalan), advised us that it might be UTI, and gave us Antibiotic (Co-amoxiclav) which make her okay on the following days.

Mid week of July 2021,

We noticed unusual bruising on her, she could get bruise easily and taking too long to fade.

July 26, 2021,

We noticed small red spots/rashes on her neck and armpit (it was called Petechiae), which triggered us day after to visit our Pedia (since we are very nervous upon searching on google that it might be a serious problem).

July 27, 2021,

Early morning we visit our Pedia (Dr Bentalan) but she was out of town due to medical mission, so we visit our other Pedia (Dr. De Leon), and prescribed our baby with Iberet syrup (Folic Acid) and conduct CBC+Platelet count, she might be anemic.

We immediately bring our Jervyna to Manila East Medical Center that morning and have blood drawn for CBC+Platelet count, that time she screamed and cried alot, it was her first time doing it.

On the afternoon, we got result, and found out that all of her counts were very low, Hemoglobin (7.7), Hematocrit (23.0), Platelet (73).

July 28, 2021,

We go back to Dr De Leon and we show the lab result, and advised us to visit nearby Pediatrician in Hospital for further checking, we go back to Manila East Medical Center and look for Pedia on OPD Building, we met Dr. Glizeria Ramirez, she wanted to see the child, but what we only brought was the CBC Result, she said that result was very alarming since all counts were very low. She advised for re-test to make sure and Peripheral Blood Smear test.

July 29, 2021,

We visit Antipolo Cathedral together with Jervyna and pray that her lab retest will be okay,

then went to InterPath Laboratory for CBC+PLT Retest, when we got the result in the afternoon, we are shocked that her platelet was now only 40 down from 76 from previous. Which triggered us that we must bring Jervyna to nearest hospital, we went to Medical City Pasig but Jervyna got fever before getting to the ER and they planned to put Jervyna on Isolation area where there are possible covid patients, so we didn't agree and tried to drive home instead, while on our way, we tried to contact the secretary of Dr Ramirez and we ask if she could accommodate, once we got to Manila East Medical Center, Jervyna was entered in ER and attended by Physician on Duty during that time, we are lucky that they allow me and Jenny to be with Jervyna while she was on ER, Jenny and Jervyna got Antigen Test and got negative result and later they are transfered to room.

July 30, 2021

Jervyna was visited by Dr. Ruiz(Hematologist), ordered several test on her like (xray, ultrasound, etc...)

July 31, 2021

Jervyna started to have nose bleeding, she got nasal pack, she got her first blood transfusion (1 PRBC + 3 Platelet),

August 1, 2021

Jervyna was visited by Dr. Rodriguez (Hematologist), explained possible diagnosis: Acute Leukemia or Aplastic Anemia, advised us to have Bone Marrow Aspiration immediately.

I've talked to my previous Prof Jay Binueza, and ask for some guidance, he provided so much advised on me and refered to his daughter's hematologist Dr. Joseph Alba,

August 4, 2021

Jervyna got another platelet transfusion that morning, while we talked with Dr Edwin, we decided to transfer to PCMC, while the MEMC cant provide us an update on possible transfer, we decided to got discharged instead, we contacted Dr Alba's Secretary and ask if we could still able to go to her clinic that morning, but discharging in MEMC was long process, we could able to discharge on the afternoon and can't make it to visit Dr Alba in PCMC. We brought Jervyna home, got Home-service RT-PCR Test needed for PCMC admission, we are very nervous all night long. We also contacted Dr Joseph Alba if he could accommodate us on her clinic on Medical City on next day.

August 5, 2021,

Got negative result of RT-PCR, we visit Dr. Alba in Medical City in the late morning, and he checked up Jervyna and wrote referral letter to admit Jervyna in PCMC, we drive from Medical City to Philippine Children's Medical Center, Jervyna was admitted later that day.

August 6, 2021,

Jervyna had Bone Marrow Aspiration performed by Dr Alba

August 9, 2021,

Late afternoon, Dr Alba called me to discuss the result of Flow Cytometry, Jervyna was diagnosed with Acute Myeloid Leukemia having 80% Blast having remarks to have FISH PML-RARa test, Dr. Alba discussed that Jervyna might have APL or Acute Promyelocytic Leukemia if she will get positive with the FISH test, but the result of test will be released after 10-12 working days from NKTI.

August 10, 2021,

Jervyna was prescribed with ATRA or All-trans Retinoic Acid, a non-chemo drug for treating APL, it is a targeted drug that will treat abnormal chromosome of t(15:17). We got a 100pcs of bottle for 15,000 pesos.

August 18, 2021,

Jervyna's 5th Birthday � and it was her first chemotherapy session with Doxorubicin.

August 20, 2021

Second Day of chemotherapy session with Doxorubicin.

August 22, 2021

Third Day of chemotherapy session with Doxorubicin.

August 23, 2021

Jervyna went to Operating Room for nasal pack removal, and it was successful

August 24, 2021

Jervyna got blood transfusion in the morning,

She got discharged and went home at night and we celebrate her 5th birthday at home. She was very happy that time

August 25, 2021

Jervyna got mild nose bleed again in the morning til afteroon. In the evening she got heavy bleeding while sleeping that drives us to send her again immediately to PCMC that night,

She was entered to PCMC Triage that night while waiting for room in ER, at 12midnight she was able to have slot in ER. FISH Result was released and she was 23% Positive on PML-RARa confirming that she was has Acute Promyelocytic Leukemia

August 26, 2021

Jervyna was still in ER, got RT-PCR Test in the afternoon.

August 27, 2021

Jervyna got negative result and later that day transferred to room

August 29, 2021

Jervyna was put with oxygen support, since her oxygen level in blood was getting low

August 31, 2021

Oxygen support was removed since her oxygen level was normalized.

September 5, 2021

Got skin rashes all over her body

September 7, 2021

Jervyna's body temperature was 35.4 and put drop light on her, she got high blood pressure 140/100, at 6am Jervyna experienced her first seizure for 7mins, got another seizure at 7am, and another seizure at 12pm, which put her having difficulty in breathing, she needs to intubate that time and we agree, she was later need to transfer to PICU for closed monitoring,

That night she was transferred to ICU of COVID Ward while waiting for covid test result.

September 8, 2021

She was transferred to PICU, under Dr. Evangelista, we wouldnt see our Jervyna until she was released

September 10, 2021

Jervyna has MRI schedule, and Jenny was able to see her while transfering from PICU to Radiology Room,

September 13, 2021

In the afternoon, We got call from Dr Evangelista, that Jervyna was extubated yesterday and was in oxygen support all night, and stopped that oxygen support in the morning, she was later put NG-Tube on her nose for food and medicine.

September 14, 2021

It was the day that Jenny will enter the hospital again to be with Jervyna but one of the patient in the PICU got positive in covid test, and they were all put in lock-down for 5days, until September 19, 2021.

September 18, 2021

Jervyna's nurse text us that Jervyna removed her NG-Tube, and told us that she can now eat/drink soft food, so we brought her favorite Yakult, marshmallow, and dutchmill, soft bread.

September 19, 2021

Jervyna got negative covid test and got call that she was about to discharged that day, we were very happy and nervous, later that day Jervyna was discharged and we brought her home in Antipolo.

September 20-October 1, 2021

Jervyna was only at home recovering, she was able to drink her medicines, eat rice and ulam, drink water alot.

October 2, 2021

We went to PCMC again for scheduled Covid Swab Test, Jervyna was very courageous and strong, she was feared but didnt screamed and cried alot during the swabbing. She was later happy knowing that she will got home after.

October 3, 2021

Jervyna and Mommy Jenny got both negative result.

October 5, 2021

We left Antipolo at 4.45am and reaching PCMC before 6am, we were at number 10, Jervyna got CBC Test and got good result having 386 platelet count. She was checked-up by hematologist at 12nn and were advised that Jervyna needs to have BMA and receive another chemo later that day.

October 6, 2021

It was her second day receiving her chemotherapy as outpatient. We arrived at 10am, started infusion of Doxorubicin at 10.30am and leaves at 12.30pm.