Preventive Medicine – Back at Sloan Kettering

What started out as a “routine” day became anything but as Debbi’s energy level faded just after I left for work. Complaining of shortness of breath, Debbi placed a call to Dr. Bajorin’s office. Shortly after arriving at my desk, Debbi called and said that Dr. Bajorin personally returned her call, listened to her symptoms and requested her to report to Urgent Care right away. Aaron was just arriving so he accompanied Debbi on the crosstown trip while I rode the train uptown. 

In short order, Debbi was given a bed and vital signs were taken. When the blood test showed a hemoglobin count of 8.6 (normal range 11.7-13.8 gm/dl), the attending physician asked for Debbi’s blood pressure to be repeated in both a prone and in a standing position. When lying down her blood pressure was 110/86 but when standing her blood pressure was only 89/68. To be safe, Debbi was sent for a cat scan of her lungs and an ultrasound on the back of her right leg as she felt some pain there. 

Both scans were clear but Dr. Bajorin recommended that Debbi receive a transfusion of 2 units of whole blood. If I thought that the double checks performed in order to verify the correctness of the chemo drugs were “thorough”, then upon witnessing the validation procedure in order to administer blood from another person, I would have to have to redefine that term.

First, the doctor ordering the blood is not told the blood type of the patient. This measure prevents a doctor for ordering a unit of type X blood. Instead, the doctor simply orders one unit of blood, the lab sends someone to draw a vial which the lab cross matches with donor blood. The bag of donor blood has identifying tags on it and a paper trail is begun showing the patient name, tag number from the blood, patient code number, patient blood type with Rh factor, product code, product expiration date (after which the blood may not be used for a transfusion), and results of the crossmatch… as well as the patient birthday which as I have written before, serves as the social security number identifier in today’s times where revealing the ssn so frequently is a potential invasion of privacy. Again, two nurses check the patients id band, ask the name, spelling of the name, and the birthdate. They double check everything including the paper trail and the identifiers on the bag of blood. When they are satisfied that all has been verified, the transfusion begins. 

The purpose of the transfusion is to boost Debbi’s red blood cells and hemoglobin count. At the chemo session this past Tuesday, Debbi received a shot of Darbepoetin for this exact purpose. The Darbepoetin is a longer acting drug so it seems the transfusion of 2 units of whole blood is meant to boost the count until the Darbepoetin gets up to speed.

Our nurse Lori, spoke to us about the importance of mental health as well as physical health. She emphasized the importance of going for frequent walks, breathing fresh air, and not simply staying in the apartment all day. So, to our friends who have taken Debbi out while I am at work, I can only say thank you and pray you continue.

We will monitor Debbi’s energy levels in the next few days and hopefully be able to report that the transfusions were beneficial.


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