Hi!
I’ve been asked about Delia’s INR, what that blood test means, and how it impacts her listing for liver transplant.  I promise, I’m going to get back to the INR, but for background, I’m Jessye’s cousin, and an ICU doctor.  As a disclaimer (unfortunately), I have to say: the information presented here is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, is for general information purposes only.  Additionally, as all medical information pertaining to Delia is obtained second- and third-hand, I cannot attest to the accuracy of the information presented here. 

Phew.  Ok, sorry.  I hate that, but it has to be done.  Back to the information at hand.  Delia has been listed for a liver transplant on a national database.  There are many factors that go into where, exactly, she is ranked in this list.  One of the main contributors, as Danielle mentioned a couple days ago, is the PELD score.  This score is made up of a few different lab tests that try to give us, as physicians, a global idea of exactly how sick someone’s liver is.  The liver is responsible for a great many critical tasks in the body, including filtering toxins (such as ammonia), creating enzymes that balance bleeding and clotting in the body, producing enzymes that help digest food, and playing a critical role in maintaining an appropriate level of sugar (or glucose) in the body.  Thus, when liver function is severely decreased, as it is in Delia’s case, we can expect all of these functions to be impacted.

So, back to this PELD score.  The three main contributing values (besides Delia’s gender, age, etc) are her albumin (a protein produced by the liver), bilirubin (a product that is broken down by the liver), and INR (see, I told you I was coming back to it!).  The INR is a calculation that’s really just based on how fast Delia’s blood can clot.  When the liver isn’t functioning properly, it doesn’t make those important factors that help blood clot when it needs to, like when Delia gets a skinned knee, or when the doctors perform a procedure (like a surgery).  So, as Delia’s liver gets sicker, we would expect the INR to be higher, that is, the time for her blood to clot to take longer.  

In general, as Delia’s liver gets sicker, her PELD score will get higher.  This is a double-edged sword.  At this point, as I understand it, we are expecting that Delia will need a transplant, based on the current assessment of her liver function.  Because of this, we want Delia’s PELD score to be high enough to rank her very high on the transplant list.  At the same time, however, when her PELD score is very high, that means her liver — and thus, Delia — is very sick overall.   When that happens, all those things we talked about the liver doing?  Those all become dysfunctional.  Toxins (like ammonia) can build up in her blood and make her confused.  She can bleed more than she should.  She may not get nutrition from food she eats, and her blood sugar levels may drop precipitously — all making surgery challenging.  

But having come from a large liver-transplant center, I will tell you that this is expected.  This is why these blood tests are checked — and scores are calculated — at least once daily.  I have spoken with multiple colleagues, several of whom are pediatric liver transplant specialists, and they have *all* said that Stanford is the place you want to be.  Delia is in amazing hands.  

So, we pray.  And we support Jessye and Nick.  And we surround them with all the love and meal cards we can, because this is going to be a long road.

If anyone has any questions that I can answer, please post in the comments, and I’ll do my best.  I’m headed in to work over the next couple of weeks, but I’ll be checking back as frequently as I can.

Best, 
Meagan Pate