Low Hemoglobin Requiring Transfusion From Pomalyst or Relapse or Both – April 10 2013

All day, Tuesday, 9 April 2013, I was short of breath and even had a difficult time getting from the sofa to the front door without sitting down quickly. My resting pulse has been in the low 70s and now as was in the middle 80s if I as perfectly quiet and lying down. Any standing or walking made my pulse soar to 100s and even 130. I have a little pulse ox finger machine and my oxygen level was fine in the high 90s…but, my heart rate was high causing the shortness of breath. I seriously wondered if I could even get myself anywhere.

I had a scheduled blood draw on Wed, 10 April 2013 at the Lost Rivers Medical Center in Arco, Idaho. My hemoglobin was only 7.5 (norms 12-16). They usually do not offer packed red blood cell transfusions until your value is 7.0 or below. However, a call to Dr. Padavanija at St. Luke’s Hospital, Twin Falls clarified my situation. Since I symptomatic with shortness of breath and high pulse, she agreed that I needed 1 unit of packed red blood cells to bring my hemoglobin up which would reduce my pulse. 

I have to have any transfusion at St. Luke’s Hospital in Twin Fall because I require irradiated blood products due to my previous 2 failed autologous stem cell transplants. The little Lost Rivers Medical Center cannot offer this.

My white blood cell count was low at 2.1 (norms 4.5-11); absolute neutrophil count (ANC) is low at 1.10 (norms 1.9 to 8.8); platelets very low at 43 (norms 140-440) and will continue Fragmin injections at half dose 7,500 units; LDH has come down some, but is still abnormally high at 913 (norms 313-618).

My chem panel was essentially normal except for my BUN which was little high at 18.3 (norms 7-17). My glucose was abnormally high at 173 (norms 70-112), but I’m on 40 mg of dex which raises the glucose and I probably ate too much sugar too.
The triage nurse at St. Luke’s Hospital in Twin Falls advised that I try to get there as soon as possible for a packed red blood cell transfusion. So, at 10:30 AM, I started out on the 2 1/2 hour trip to Twin Falls, I may have exceeded the speed limit a tad and I made it in 2 hour hours 15 minutes. 

I was pooped when I arrived.
The Infusion Nurse Vicki accessed my Bard Power Port and sent a Type and Cross Match to the lab. After that was back, they ordered the one unit of irradiated Type A+ or O+ packed red blood cells. They sent Type 0+ Leukocyte Reduced. Again, I am thankful for volunteer blood donors that make this transfusion possible.
RN Rhonda ran the blood through a blood warmer and it took about 1 1/2 hours to run.

 Thankful that I have an implanted Bard Power Port and ever present MacBookPro.

This blood transfusion was only my 5th one since my diagnosis almost 23 months ago. And my only transfusion that was not during an autologous stem cell transplant. 

History of All Blood Transfusions Since Diagnosis May 24 2011
  1. Apr 10 2013
  2. May 16 2012
  3. April 2 2012
  4. Sept 22 2011
  5. Sept 7 2011

We decided that I would go to Lost River’s Medical Center in Arco, Idaho on Friday, 12 April 2013 and have my complete blood count repeated. Until then, I am to HOLD the pomalidamide (Pomalyst) and we will consult over the phone on Friday on how to proceed based on the lab values.
I complained of  a NEW deal happening in my right eye – where a brownish area with black pulsing dots was floating around in my right eye that I could not see through. Dr. Padavanija thought I should see an ophthalmologist as soon as possible and made an appointment for me for tomorrow at 10 AM. I was a tad worried about it and glad I could see a specialist so soon. Idaho is NOT like Colorado – specialty doctors are NOT on every corner and the norm is to wait for an appointment.
In the matter of an afternoon, I was a whole new person without shortness of breath, but I had a new weird thing in my right eye.  Really hoping it was related to low platelets, anticoagulation therapy, et.

Had no difficulty driving home 2 1/2 hours – had to wait for the train in Shoshone, but I was patient. 
I arrived home just before it started to get dark.