Miracles are unusual

While I was in hospital I was pleased to receive a visit from my friend, Dr W. Dr W's story is remarkable.

I first heard about him when he was a young doctor in Nigeria. One day a junior doctor in my own hospital came to see me at the end of my out-patients clinic. Would I be prepared to perform a bone marrow transplant of a friend of hers from Nigeria?

I explained to her that I would only be able to do so if he had the funds to pay for it. I expected to hear no more, but a few weeks later she came back and told me that there had been a coup in Nigeria and for a short period her husband, a civil servant, had become Minister of Health. During that period he had managed to find the money to pay for Dr W's transplant.

The next week he arrived in the UK and my secretary found him a room to stay in.

The first thing was to make a diagnosis. This turned out to be very unusual. He had multiple myeloma with a high paraprotein. He also had red cell aplasia, which meant that he needed transfusions every week. There were no cases in the literature with these two conditions, but it seemed to me that they had to be linked. Most likely the paraprotein had antibody activity against red cell precursors or erythropoietin. We could not demonstrate this to be true in the test tube, but we set about trying to reduce the paraprotein by chemotherapy and plasmapheresis. In fact neither this nor any of the subsequent treatments that we used did anything for his pure red cell aplasia. He eventually had an autograft which put his myeloma into long term remission, but nothing halted his need for weekly transfusions of red cells.

Of course he ran into transfusion problems. Despite the fact that he had received 76 pints of blood in Africa he had not contracted either hepatitis or AIDS - his donations had all come from members of his evangelical church, who clearly walked the walk as well as talking the talk. But this was no help against iron overload and as he developed cardiomyopathy from this we had to institute an aggressive iron chelation policy.

Dr W was a keen Christian and a fine singer and even though he was unable to practice medicine over here, he found a useful life in Christian ministry and song after I obtained for him permanent residence in the UK. Remarkably he remained in remission as far a his myeloma went, but he still needed a pint of blood a week to keep him alive. Then remarkably, a couple of years ago he stopped needing the transfusions. Even more remarkably he changed his blood group from A to O. Since then he has not needed blood and is living a normal life.

I don't expect to see miracles. But is was surely strange that his ticket to come to the UK was furnished by such a happy series of coincidences. Of all the places that he might have come, he was fortunate to hit upon one of only 10 Christian hematologists in the UK. His remsiion from myeloma of 19 years is the second longest I have seen, and spontaneous remission of pure red cell aplasia must be very rare, but I have never seen a person change their blood group.