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Monday, October 8, 2007

Blood Transfusions 101

First, the only real news I have regarding the purpose of this blog. I have 5 hours of tests next Monday a Scripps Green. Then Tues I see the dentist to get my teeth taken care of. It's not advisable to have dentists digging around in the mouth giving germs new places to setup shop. The immune system is still trying to reestablish itself for a year after a stem cell transplant. Now is a good time to see Dr. Needle. Speaking of the sharp doctor...
Ok. Read on. This will not be your average text-book read on blood transfusions.

Blood Transfusions 101.

This is what I've learned and experienced since Jan 26, 2006 when I was diagnosed with MDS, became transfusion dependent, and consumed 35 bags (17.5 liters) of Red Blood Cells. Pardon any irreverence you may discover below. This is the way I deal. Thanx.

What is transfused blood?
In a nutshell, transfused blood is usually packed, leuko-reduced and irradiated. Each 300ml packed is equivalent to 500ml unpacked. What is packed? They take the donors blood and pour it into a big wooden tub and have an Italian family stomp on it wearing nothing but shorts and tank tops. That packs it down a bit. To finish the packing process they run it thru uncle Jed's moonshine 'still' to remove about 40% of the H2O. Finally they stick it in a GE 1000watt microwave oven to 'irradiate' it. The end product is guaranteed to be 151% proof, redder than normal blood and free of common household pests.

The pint bags of blood are, of course, donated from kind people. The questions for xfusers like us are, who, when and where? The why, how, and the what are pretty well documented. The answers we seek will remain a closely guarded secret by the industry. Obviously, xfusers having answers to these questions will serve no purpose other than to make us nervous, paranoid, and litigious. We have to trust the medical industry to maintain the integrity and purity of the blood supply. They seem to do a pretty good job at that. So I wont alarm you by passing on idle speculations and rumors about what I've heard about the identity of donors.

Transportation to the Chemo room
The donated blood is rushed from the local prisons to the processing centers located very close to the facilities. There, the blood is processed as outlined above. After processing, the blood is poured into small plastic bags with a dozen little tubes hanging out the bottom. One of these tubes will eventually lead into your arm. The other little tubes are from the bag's previous escapades with other patients. The bags are stuffed into an old red igloo cooler packed with mystery ice. The cooler is rushed over to your clinic in an old truck very much like the one they use for public transportation at toon-town in Disneyland. The truck shakes up the blood, infusing vast amounts of oxygen; enough to support an small aquarium full of saltwater blow-fish for up to 3 weeks. Doctors say the extra oxygen is good for you.

The Chemo room. (The info from here on is actually from personal experience)
Once you arrive at the chemo room, which, if you are lucky, will be in a hospital, but in my case is directly behind the Pfizer plant in a run-down section of SE San Diego, grimacing nurses will direct you to a very old tweed recliner. I'm sure I've seen that recliner under Carroll O'Connor's butt on TV years ago. When you sit down, metal straps appear out of the chair's arms to restrain your arms. Naw! Just kidding about that. The nurses actually use plain old cloth straps. The nurses get to work. They open their red tackle box and pull out special needles made by Gamakatsu, the leading fish hook manufacturer in the world. I think the needles have serrated edges in order to keep them from sliding out during the transfusion. After several minutes of slapping your arm looking for, and eventually producing, bulging veins, a nurse somehow gets one of the large, serrated needles into your arm. I'm not exactly sure how that happens cuz this is where I always black out. When I come to, there is a needle and tube protruding from my arm and it is secured by duct-tape that seems to cover my whole arm. My entire left arm was rendered hairless months ago. The nurses say hair just 'gets in the way' and besides, hair removal with tape works so much faster than shaving. Before they get to the blood, the nurse first insists on transfusing you with some kind of clear liquid, which I believe is cheap Vodka. I dont know this for sure but I feel very woozy once they switch the turn cocks to let the blood start dripping through the plastic tubing. I think the Vodka is also supposed to lessen the impact of you having to slowly watch Charlie Manson's (bless his heart for donating from the prison) blood slowly make its way through 37 feet of clear plastic hose. I understand they have shorter and opaquer hoses handy but they get a kick out of watching patients fidget as they watch the bright red blood make its 10 minute journey through the clear hose into your arm. By the time the blood has reaches the point of no return near the entry point you could swear you see things swimming in it. I suppose the nurses deserve to have their fun.

The Transfusion
The speed of the transfusion depends upon your age and how much the nurses like you. If you are older they slow down the pump so that 'bad things dont suddenly happen'. The nurse takes your pulse and blood pressure frequently just in case, well, that the blood got mixed up somewhere during the packing or labeling process. If you are younger or they just dont like you they will put the pump in turbo mode. This is cool if you want to get out of there fast, which most everyone does. But this is not cool if you are accidentally receiving type B negative blood when you are A positive. If you survive the first 20 minutes or so, when the nurses temporarily leave the room you can press a couple buttons on the pump, speeding it up so you can make your 3pm shrink appointment. The whole process takes around 2 hours per pint, so bring plenty of reading material. What with the Vodka flush, the benedryl and the tylenol they give you up front, time passes pretty quick. Dont be surprised if you fall asleep. To snap you out of your tranquility when the transfusion is over, the nurse will gleefully remove the duct tape wrapped around your arm... very slowly. Then she will yank the fish hook from your arm. Finally, for no apparent reason, she will slap the insertion area on your arm. I've learned to yank my arm away before the slapping begins, and have been none the worse off for it. Your choice.

The Aftermath
Its probably different for everyone. But you should feel more energetic since the oxygen carrying capacity of your blood has been greatly enhanced by Charlie's kind donation. As the oxygen makes it way into your brain, your brain suddenly wakes up, remembering where you left your wallet, your keys, your dog. Its quite euphoric actually. You feel like you can actually climb that flight of stairs now, and get past '2 across' on the crossword puzzles.

Side Effects
Yes, there can be unwelcome side effects. After 35 pints I've only had a slight rash on my wrist and ankle after 1 transfusion. In regards to other side effects, do *NOT* look on the internet for side effects, especially do not look on any Jehovahs Witness web sites! Ok, I'll break it to you easy. The JV is that when you get a blood transfusion you get 'traits' from the donor. So, for example, if the donor was a murderer... you may start thinking very... dark... thoughts. Obviously hogwash. Strangely enough though, I've taken up humming to myself in the last few months. And, my handwriting has gotten a lot better. Mmmmm... Then, these 2 words keep popping into my head lately: "helter skelter". What does it mean?

Hope this helps!


Your Loving Wife said...

You scare me, honey! Now I understand why you are whispering sweet Italian phrases in my ear...I thought you were planning a romantic European I understand you may be planning on breaking my leg or tossing me into the ocean with a cement ankle bracelet...Yikes!