At my surgery pre-admission appointment a couple of weeks back I received an overwhelming amount of information. One of the most significant things I learned is that my hemoglobin level is low, which is why the doctor who saw me at the end of the marathon appointment advised me to eat as much red meat as possible every day leading up to surgery. Because of my low blood level I had to meet with the Blood Conservation Team on Tuesday afternoon. At the hospital where I’m receiving treatment, this group is also called Patient Blood Management, but the nurse assigned to manage my case didn’t just manage me. She was incredibly supportive and educated me extensively about what she would do to help me increase blood levels to prevent the chance I might have to have a blood transfusion during surgery; and the associated risks attached to that help.
My nurse’s name is Anna. Her support started last week when she called me after my pre-admission appointment to assess my overall health and schedule my blood management appointment. She explained that the primary concern about my hemoglobin level is that since I had bloodwork completed in February my blood level has dropped by more than ten points from 126 g/L down to 111 g/L. The normal hemoglobin level for adult women is from 120 g/L to 160 g/L. According to Anna, the one positive is that because I have been taking iron supplements since becoming ill I have iron stores to build on – just not fast enough before I have surgery. We also discussed my high blood pressure that I now have because of my pain, and which she sees as another point of concern. Anna became very sympathetic when I explained the full circumstances of my illness and how it has decreased my quality of life over the past two years. After discussing the rest of my medical history, she explained what she felt was the best solution for me.
So how do they increase your hemoglobin level within weeks, or in my case a week, of having surgery? First, they change your iron supplement to one that is more easily absorbed. In my case, the iron supplement I started taking just over a week ago is FeraMAX. It is specially coated so it “allows the iron to pass through the stomach relatively intact where it is absorbed through the small intestine and is then delivered to the bloodstream.” Simply put, I’m getting bigger doses of iron now, and I hope this higher dose will make a difference. The second part of the treatment is to get an injection of a drug called EPREX, which I received during my appointment with Anna on Tuesday. The active ingredient in Eprex is “epoetin alfa, a protein that stimulates bone marrow to produce more red blood cells.” The dose I received came in a prefilled syringe that Anna injected into my upper left arm. I have a bit of a needle phobia, which means I squeezed my eyes shut as she uncapped the syringe and found the right spot for injection on my arm. Anna warned me that the Eprex solution is very thick, which translated means it hurts like hell when it’s plunged into your arm.
As beneficial as that single, $500, dose of Eprex should be Anna did educate me about the potential side effects. The least complicated side effect is feeling like you might have the flu within a day or two of receiving the injection. I’m happy to report that I did not experience a fever or feeling achy all over my body from a painful shot in my arm. Moving down the list – or would that be up because of severity? – would have been a severe allergic reaction to any or all the ingredients in Eprex. I’m also happy to report that I have not had a rash and/or itching at the injection site, nor did I go into any phase of anaphylactic shock immediately after. Last but not least: blood clots. This side effect is one that might take a little longer to detect. It will depend on how much my hemoglobin level increases, which may affect the thickening of my blood. The one thing that might offset this is that during surgery next week I will receive blood thinners, which I assume is the primary reason having a low hemoglobin level beforehand is so problematic.
So, will I have more blood in me by next Tuesday? According to Anna, they usually see the best result seven days after a single dose of Eprex. Fingers crossed that this will be true for me. Otherwise, when I’m done with all of this surgery business, they will have to get to work on figuring out why I don’t have enough blood.
Foreigner – Hot Blooded