Blood Tests and Transfusions

First, if at all possible, you readers who are not afflicted or aged, please donate some blood.
Click here to find a convenient donation opportunity near you.

I just entered the Beaufort Zip and up came 7 choices Within 10 miles of ZIP code 28516 
in March and April! And this is the Beauzone, the outer-outer banks, the end of the cord.

You can't earmark your donation for a specific person, it all goes in the bank.

When you make a donation to the Blood Bank, you are making a deposit in your Karma Bank
And we all know that  " whatever Karma wants, Karma gets"   Just do it.

Roll up your sleeve and let us get started! Click to jump, and enjoy the soundtrack from who else but
Blood, Sweat , and Tears.




Soundtrack!

Bookmark this site. 

. http://labtestsonline.org/understanding/

At some point you will need to have blood tests done, in fact, you should ask for a blood test at your next check-up. If I had discovered my MDS way earlier, I might not be going through all this now.

1. Collect
2. Analyze
3. Transfuse

Your blood is drawn and analyzed, and if some components are sufficiently low, your Doctor will order a transfusion.

It is like checking the dipstick in your car's engine, and if you are a quart low, you need to add some, especially if your check engine light is on, or has been on for a while and you used the Click and Clack's  fixing of putting tape over it. (that is called denial and avoidance)

When I went on  Monday (yesterday) for my regular weekly blood test, I, knew my check engine light was glowing. I had the rushing, Doppler effect in my ears and felt faint if I stood up to fast. So I knew it was transfusion time again.

The Draw or Collection by the phlebotomist

Make sure they wash their hands and give you a good alcohol swabbing before the stick. It is ok to fan away the alcohol,  as the needle can pick it up and that stings, but don't blow on it to hasten evaporation, lest you contaminate the area. Just let it dry, and think good thoughts. With the good vampires, you never even feel it.

Usually, two vials are all that is needed, one to analyze, and  one to match up with the blood in the bank.  There are stringent procedures that are followed to ensure that the blood you get transfused with is a match with the sample you provided.  It starts with a wristband you will wear until the transfusion is complete.

Wrist  Band with the Yellow Stickers

Jeez, I didn't realize how wrinkly my wrist has gotten.

These stickers  follow the sample  through the matching process at the blood bank and are read in again and verified by two witnesses at the time of transfusion.

Surprise! Big Draw Today !

Since I am getting close to my transplant, Duke Med (4 hours away ) requested a bunch more labs be done here at the Raab, so instead of my usual 2 vial draw, I had a 12 vial draw.

As I counted up all the blood I have had drawn in the last 10 days, including  6 of these cool little bacterial culture bottles 

the same size as South Carolina Likker Bottles,

I was sure I would need topping off to get me through this week of moving up to Durham for the transplant.

 Back to the procedure,

Test tubes with purple tops have an anti-coagulant already in the tube - they are the ones that go on a rocker to mix, and thence into what I have dubbed "The Hemalator " for analysis. This amazing machine performs a Complete Blood Count or CBC. A test tube in one end, computer print out the other, rinse cycle, sterilize, and ready for another sample, in just minutes.

This is an amazing device, I have watched it being  serviced and calibrated.

And some of the samples goes to Carol, aka "The Hemolatrix "  for the manual dif.

She has slides and dyes, and verifies the Hemolater's results , and looks for and records misshapen  and irregular cells that the Hemolater is not sophisticated enough to spot. 

( So Carol, why isn't it called an "Ocular Differential" when the ANC ( absolute Neutrophil Count ) 

is determined visually? )

 One Neutrophil,Two Neutrophils...oops make that Point One in my neutropenic state.

What Carol is looking at:

Hypogranular neutrophil with pseudo Pelger-Huet Nucleus in MDS.

Test Results!

(I edited this to just show the Hemo-goblins and Platelets, the criteria for a transfusion.) 

AUTOMATED BLOOD COUNT
                                                                   Reference ( where it should be )
 HEMOGLOBIN          *7.8           low                 [13.7-17.3]


 PLATELET COUNT    *40             low               [150-450]

OK, the results say my Hemoglobin is at 7.8, and that is the below threshold  of  8, above which  my insurance will not cover a transfusion. Platelets are low, but not low enough for insurance to cover a platelet transfusion. (but low enough that I will bruise easily and cuts will take a long time to scab over, and maybe bleed internally.)

NEXT:

The vial with the yellow sticker from the wristband on it gets sent to the Blood Bank or Lab, depending on how far out in the sticks you live.  It is tested for compatibility, and may take a day or two to get units of blood that are safe to transfuse with.  It is not just Type and RH factor, there are antibodies that must be screened for, as many as thirty, and other factors of incompatibility that have not yet even been discovered, but can cause mysterious reactions.

The Blood Bank

A UK blogger showing what happens at a Blood Bank. 

 A Pet Blood Bank! Doggies need blood too.

How much different can it be? Click here pet lovers!

An aside:

Each unit of blood has an expiration date.  I finally figured out that there is a correlation between expiration date and time between my transfusions.  The fresher the blood,  the longer I can go between transfusions. Duuuuhhhh..

Just like the "musgo today" corner of the meat display at the Piggly Wiggly, you can roughly guess how fresh the unit of blood is by the color. If it is starting to look too brown,  you can turn it down.  I have never turned down a unit, though, because it is so precious, and donors are so few, and for a while when I had some antibodies, it took a couple of days to get the units driven out here to the end of the Extension Cord,
on the Outer-Outer Banks.

1 unit of PRBC, Packed red blood cells,  Irradiated, filtered, typed, tested, re-tested, chopped and channeled,  stroked and bored,  inspected, selected, refrigerated, delivered. Price varies with location.

Finally, The Transfusion

Again, this is a procedure, a ritual with many steps that must be followed, and precautions taken to minimize or negate chances of contamination.  Basically, either a port or a Hickman catheter is accessed, or an IV started, and the connection is made between your circulatory system and the bag-o-blood.  ( it is a plastic bag too,  see rant about plastic in the previous post )

Reading in the bag: Two nurses verify your name and DOB, and the numbers on your yellow sticker wristband, which you better not have cut off, or lost somehow.

Hooked up. Note bag of saline for flushing the tube on left, blood on right.

Note Pump, Blood pressure machine on the wall, obscuring the  picture of  Cape Lookout Lighthouse, the same lighthouse you saw back in  the quarantine post of March 12, Note too the side of the Genuine Naugahyde Barca-lounger Recline-o-matic chair with the wing tables.

Platelets

Platelets:  Basically the same procedure, but a gravity feed  simply regulated by the bore of the needle, and the sliding clamp on the tube. Platelets go fast, may 20 min an avg. bag. Looks like Orange Juice.

edit March 25. At Duke, platelets are run through the pump.

If you think you need platelets, have petechiae ( red dots ) on your extremities, and are bruising very easily, point it out to the nurse who does your draw, and maybe get banded for a platelet transfusion. The match is somewhat less important, shelf life is shorter, and collection is more complicated.

Vital signs ( Blood Pressure and Temp) are checked before the transfusion starts, 15 minutes in, and then every hour. This is done on each bag.  Depending on the feed rate and volume of the bag,, it takes about an hour and half or two per bag, and I usually get the twofer special, the double bagger. On the front end there is a sign in, between bags and at the end, there is the flush, and the heparin (anticoagulant) flush if you have port. then de-accessing and clean-up.  If you get two really full bags it can run 4-5 hrs. But you will probably die without it, so just sit back and enjoy the ride. Bring your kindle or  iPod.  Most chemo cafes have wi-fi.

I usually play my Yamaha practice guitar through headphones, which is basically silent. If things are slow in the infusion chamber they hook me up to some little  powered speakers, and coerce me into playing  queasy listening lounge lizard background music to accompany the incessant beeping of infusion pumps and blood pressure alarms which, incidentally, are in the key of C.

Cost?

Are you sitting down? 2010 article.

IRVINE, Calif., April 5 /PRNewswire-FirstCall/ -- A new blood transfusion cost analysis study published in the April 2010 issue of Transfusion, a peer-reviewed academic journal, shows that when all of the complex cost factors leading up to and after a red blood cell (RBC) transfusion are considered, the actual cost of blood is substantially higher than previously estimated.  With actual blood transfusion costs ranging between $522 and $1,183 per-unit—37% higher than estimated by prior studies, which did not include all associated costs—the new study calculates that the true cost of blood is 3.2 to 4.8-fold higher than reported blood product acquisition costs.(1)  

1) Shander, A., Hofmann, A., Ozawa, S., Theusinger, O., Gombotz, H., Spahn, D.  "Activity-based Costs of Blood Transfusions in Surgical Patients at Four Hospitals."  Transfusion. April 2010, Volume 50, Issue 4, Pages 753-765.  Available online here.

RISKS: Reactions

There are a couple of ways that this procedure can go awry, in spite of the care taken by the collection, lab techs, blood bank, and delivery people, and the final administration of the "product".

 Acute hemolytic transfusion reaction, and  Febrile Non-Hemolytic Transfusion Reactions.

Google them if you want.

In over 150 units I have experienced only one reaction, and it was about two minutes into the second bag. There was no clerical error.  There is no blame implied or intended.

All I can figure is that while both bags were compatible with my blood,
the second was not compatible with the combo of my blood with the first bag added to it. 

I got the shakes, almost to the point of rigors.  Only from the waist  up. I was thinking , St. Vitus Dance? What is going on with my body?  Involuntary shivers and twitches.  We shut down the pump, and  Benadryl brought me down. The nurses came in and sat around me and monitored my vitals.  I shook off the Blood Ox clip. It was like Joe Cocker on steroids.  On the following Monday, one of the nurses asked me if I was going to put on another show. If I had had my Mandolin, I would have played some wild tremolo.  Luis saved my life.

Other Risks:

Iron build up, aka increased Ferritin Levels, requiring Chelation drugs or therapeutic phlebotomizing ((leeches). 

Can wreak havoc with your Spleen and/or Liver and/or Kidneys . ( your filters) 

This Iron build up can be lethal. My level  is through the roof, another factor in my decision to go for the transplant. It won't get rid of the iron, but I won't be adding any more, and after my sister's stem cells kick in, and my refinery is putting out product, I can break out the leeches.

And that's all I have to say about that. Forrest Gump quote.

Chris