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Old 07-02-2016, 07:32 AM
 
Location: colorado springs, CO
3,996 posts, read 1,774,084 times
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I will try to keep this as concise as possible:

48 yr old female with 17 yr history of microcytic anemia that did not respond to oral iron therapy. Both the initial traumatic blood loss & exacerbating factors were OBGYN related. Exacerbating factor was resolved in 6/2015 with surgery but left me as a non-menopausal (menstruating) female with a baseline Hemoglobin of 7. I have lived at 7,000ft elevation the entire time.

(Sorry for the TMI but it's highly relevant as this is not a diet or chemo related issue.)

Have had 8 units of blood transfused in past year; the first 4 were around/during/after surgery, the last 4 were on 5/24/2016, 6/23/2016 & 2 units yesterday(7/1).

My question is; how did the blood transfusion make you feel? I have tolerated each one very well with no symptoms of adverse reaction.

My first one left me literally "tipsy" for 3 days. It was the first time in so many years that I actually had blood cells in my body that were capable of actually carrying oxygen. I felt "high" on oxygen.

Now that I'm more used to them the experience is not quite so dramatic but it's still disruptive:
1-2 nights of 4-5 hrs of sleep, feeling slightly "manic", etc...

I like it in a way; sure does beat getting worn out from walking from the bed to the couch & I lose an average of 8-10 lbs for each unit transfused just from the increased activity tolerance (which I could use after putting on 60 lbs over the course of this ordeal).

I'm slightly concerned that this is almost an addictive type pattern but it's been a long, tiring last 17 yrs so I don't think I'm too worried about it; I deserve this now!

Anyone else here experience anything remotley similar (I've been an RN for 24 yrs & have administered many transfusions & NEVER heard a patient say such a thing!)?
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Old 07-02-2016, 08:49 AM
 
122 posts, read 58,601 times
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I am a CRNA. I also have transfused many but received only one transfusion myself as a patient. I did not get that feeling because it was a one-time acute situation.

I think it is normal, of course, to feel much better after the transfusion if you have been anemic. Chronic conditions are the pits. I don't think it is an addictive pattern unless you count feeling normal after being so fatigued as a problem.

I can't say I have heard any patient say he or she feels a "high" but have had many say they feel so much better. I am at sea level, but I would think being at high altitude would intensify the effects of both the "highs" and the "lows."

Sorry you have had to go through this.

Added: have you mentioned any sleep problems to the MD or NP?
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Old 07-02-2016, 10:56 AM
 
Location: San Antonio, TX
10,860 posts, read 18,875,631 times
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I've had a blood transfusion because of female bleeding issues. I put off going to the doctor until the really heavy bleeding had been going on for two weeks, because I was taking care of my parents while my mom recovered from a septic infection and I couldn't leave them alone. By the time one of my sisters came to town to watch them, I had to go to the ER. I was feeling pretty horrible because of the blood loss, couldn't raise my arms, my heart kept pounding, I felt very cold and tired. I didn't really feel better after the transfusion, still exhausted, shaky, tired and very cold. I was still bleeding, so they prescribed a stronger medication to stop it. I slept just about the entire month after that and I still had trouble with weakness in my arms and getting tired very easily for a while after that.

I have a bunch of weird allergies now and sometimes I wonder if they were somehow related to the transfusion, because I've had allergic reactions to medications the first time I took them and that's not supposed to happen if you've never been exposed to it before.
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Old 07-02-2016, 12:13 PM
 
Location: colorado springs, CO
3,996 posts, read 1,774,084 times
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Quote:
Originally Posted by Achelois View Post
I am a CRNA. I also have transfused many but received only one transfusion myself as a patient. I did not get that feeling because it was a one-time acute situation.

I think it is normal, of course, to feel much better after the transfusion if you have been anemic. Chronic conditions are the pits. I don't think it is an addictive pattern unless you count feeling normal after being so fatigued as a problem.

I can't say I have heard any patient say he or she feels a "high" but have had many say they feel so much better. I am at sea level, but I would think being at high altitude would intensify the effects of both the "highs" and the "lows."

Sorry you have had to go through this.

Added: have you mentioned any sleep problems to the MD or NP?

Hi & thanks for the reply!

Yes, chronic anemia IS the pits! It is so all-encompassing! Everything becomes altered; even my emotions become somewhat "blunted" as I literally won't have the energy to feel angry, or happy or anything.

Besides the palpitations & shortness of breath there is the altered digestion (made worse by the oral iron), photosensitivity, thermal-sensitivity & it just makes you look, well, ugly.

Elevation: Huge factor for me & I didn't even know about all that for a while...There is something called the Oxy-Hemoglobin Dissociative Curve & it's complicated to understand (for me, at least).

It's dissapointing that many physicians in Colorado don't have a working knowledge of it, as Colorado has the highest mean elevation of all 50 states. Doctors that work with Everest ascent teams in Nepal do but thats not helpful for me!

It's annoying to have some ER tech congratulate you on your PaO2 of 100% because I'm sure I will sat at 100% right up until my very last breath via Compensation.

Oh & actually I haven't mentioned the sleep issue yet because it seems so odd; no discomfort, not even tired! Makes me wonder if 8 hrs of sleep with a Hgb of 7 = 5 hrs sleep with a Hgb of 9?
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Old 07-02-2016, 12:24 PM
 
Location: colorado springs, CO
3,996 posts, read 1,774,084 times
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Quote:
Originally Posted by Hedgehog_Mom View Post
I've had a blood transfusion because of female bleeding issues. I put off going to the doctor until the really heavy bleeding had been going on for two weeks, because I was taking care of my parents while my mom recovered from a septic infection and I couldn't leave them alone. By the time one of my sisters came to town to watch them, I had to go to the ER. I was feeling pretty horrible because of the blood loss, couldn't raise my arms, my heart kept pounding, I felt very cold and tired. I didn't really feel better after the transfusion, still exhausted, shaky, tired and very cold. I was still bleeding, so they prescribed a stronger medication to stop it. I slept just about the entire month after that and I still had trouble with weakness in my arms and getting tired very easily for a while after that.

I have a bunch of weird allergies now and sometimes I wonder if they were somehow related to the transfusion, because I've had allergic reactions to medications the first time I took them and that's not supposed to happen if you've never been exposed to it before.
Hi; interesting reply! Oddly enough I HAVE heard of this...even from some of my patients that I've administered blood to. Now that would be an interesting research topic! BTW; I noticed your location; I actually put 3 kids & the dog into a 19 yr old Nissan 2 years ago exactly, to the day & drove until I reached the ocean & that wonderful sea-level; I felt like freakin' superwoman!

Until it was time to come home...I literally cried...

Last edited by coschristi; 07-02-2016 at 12:25 PM.. Reason: spelling
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Old 07-02-2016, 12:42 PM
 
122 posts, read 58,601 times
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Quote:
Originally Posted by coschristi View Post
Hi & thanks for the reply!

Yes, chronic anemia IS the pits! It is so all-encompassing! Everything becomes altered; even my emotions become somewhat "blunted" as I literally won't have the energy to feel angry, or happy or anything.

Besides the palpitations & shortness of breath there is the altered digestion (made worse by the oral iron), photosensitivity, thermal-sensitivity & it just makes you look, well, ugly.

Elevation: Huge factor for me & I didn't even know about all that for a while...There is something called the Oxy-Hemoglobin Dissociative Curve & it's complicated to understand (for me, at least).

It's dissapointing that many physicians in Colorado don't have a working knowledge of it, as Colorado has the highest mean elevation of all 50 states. Doctors that work with Everest ascent teams in Nepal do but thats not helpful for me!

It's annoying to have some ER tech congratulate you on your PaO2 of 100% because I'm sure I will sat at 100% right up until my very last breath via Compensation.

Oh & actually I haven't mentioned the sleep issue yet because it seems so odd; no discomfort, not even tired! Makes me wonder if 8 hrs of sleep with a Hgb of 7 = 5 hrs sleep with a Hgb of 9?


Yes, that pesky oxyhemoglobin dissociation curve! Most healthcare providers don't have to work with it much. Pulmonologists, cardiologists, anesthesia providers do. I couldn't tell you the finer points, but we take what we need for our daily work.

You are right--PaO2 is only part of the equation. If I may ask, where are you at 7000 ft. I know Denver is about 5,000, IIRC.

One of the PACU nurses stopped me one day because she had a patient who had been awake on arrival to PACU whom she couldn't arouse now, but who also had a PaO2 of 100. She hadn't given any pain meds to the patient. I asked to get blood gases and gather supplies for intubation. After the blood was drawn, I bagged the patient. Got the results: sky-high CO2. Tubed the patient and ventilated mechanically for a while, then the patient was fine and we extubated.

Last edited by Achelois; 07-02-2016 at 01:04 PM..
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Old 07-02-2016, 03:01 PM
 
Location: colorado springs, CO
3,996 posts, read 1,774,084 times
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Quote:
Originally Posted by Achelois View Post
Yes, that pesky oxyhemoglobin dissociation curve! Most healthcare providers don't have to work with it much. Pulmonologists, cardiologists, anesthesia providers do. I couldn't tell you the finer points, but we take what we need for our daily work.

You are right--PaO2 is only part of the equation. If I may ask, where are you at 7000 ft. I know Denver is about 5,000, IIRC.

One of the PACU nurses stopped me one day because she had a patient who had been awake on arrival to PACU whom she couldn't arouse now, but who also had a PaO2 of 100. She hadn't given any pain meds to the patient. I asked to get blood gases and gather supplies for intubation. After the blood was drawn, I bagged the patient. Got the results: sky-high CO2. Tubed the patient and ventilated mechanically for a while, then the patient was fine and we extubated.

Well; you have no clue how much you just made my day by telling me this! I'm not kidding, talk about feeling validated!

Yesterday when I got the 2 units of PRBC's I had actually gone in thinking I could get an order for home O2 prn (my primary was out of the office until Tuesday as well as his nursing staff).

I'm taking my 3 youngest kids camping at the Great Sand Dunes National Park (between 8,900-11,000ft elev) tomorrow. There are no medical facilities for over 150 miles from where we will be & my dumb period is going to start any minute now. My Hgb AFTER last weeks transfusion was 7.5.

Additionally, my youngest (age 12) is disabled (profound Autism) & he is 5'9" tall & almost 200 lbs; more energy than the energizer bunny.

The "Order of the Universe According to Managed Care" being what it is, the doctor needed me to stay hypoxic for at least 15 min before she would be "allowed" to write the order...

It was hysterical; looked like a freaking Cardio class going down in room 8: The doc's in the room with me leading me in the squats "1 & 2 &...!" The unit clerk is yelling at me from the nurses station "Oh c'mon; you call that a squat?!"

It just would not happen; I got down to 88% once or twice but couldn't really maintain anything lower than 93%. I started to feel syncope coming on... I'm certain I could have gone unresponsive WITH an adequate PaO2.

The doc finally decided to go with a plan "B" & nix the O2 but transfuse until I was over 10 (Hgb) & write for Provera so I could stop/slow down menses.

She said "I just can't compete with your compensation!"

I live in Colorado Springs; only about 60 miles south of Denver but it's actually on the foothills instead of east of them. I think our "legal" elevation is right around 6,500 but that is highly dependent on which neighborhood you are in:
My house is about 6,500 ft but my daughters school is at 7,100ft. My parents house is around 7,200 ft. There is one area to the SE of me that is 5,500ft & I believe thats about as low as we go.

I thought I was going crazy because I started feeling as though I could tell when the elevation had changed in almost "real-time" so I downloaded an app on my phone to see if it was just all in my head...& it wasn't!
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Old 07-02-2016, 06:59 PM
 
122 posts, read 58,601 times
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I was wondering why you stayed at such an altitude with an anemia, but I see now you have family. well, I wish you the best. You seem to have a great attitude.
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Old 07-03-2016, 12:01 AM
 
Location: Florida Gulf Coast
4,083 posts, read 5,496,975 times
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Quote:
Originally Posted by coschristi View Post
Hi; interesting reply! Oddly enough I HAVE heard of this...even from some of my patients that I've administered blood to. Now that would be an interesting research topic! BTW; I noticed your location; I actually put 3 kids & the dog into a 19 yr old Nissan 2 years ago exactly, to the day & drove until I reached the ocean & that wonderful sea-level; I felt like freakin' superwoman!

Until it was time to come home...I literally cried...
San Antonio is near an ocean???
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Old 07-03-2016, 06:55 AM
 
4,783 posts, read 4,663,039 times
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I know they give people shots (EPO) to people with kidney issues/cancer but do they have anything else they do for people whose issues do not stem from these problems?

My MIL went into the hospital for anemia/kidney failure and she was barely breathing with a 6.5 hgb. They gave her two units and she didn't feel euphoric but hey she was able to breath again. Maybe you'll have to try getting transfused at sea level and see if you have the same effects.


My only worry about constant transfusions would be the possibility of developing an antibody---of course some people are transfused a million times and never get any and some people get transfused once and develop three or four. The other day there was a patient who had a VERY rare antibody (high incidence antigen) and it's possible with that antibody she might not even be able to find a unit antigen-free.
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