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briarrose
05-14-2008, 03:16 PM
Hi everyone,

I've had 2 blood donations and I have 1 more to go (they're all a week apart). My hemoglobin was 15.3 g/mL the first week, and 12.3 g/mL the second week which I thought was kind of scary. The second donation did not go well. I had bruising from the first week and it took many tries for about 4 people to finally get the vein and I even have good veins! I could barely move my arm the rest of the day because it hurt so badly and was swollen. It's better now but I have a really nasty bruise. I've been feeling light headed and low energy. I've been trying to drink more and eat more iron rich foods but it doesn't seem to be helping. If I feel this lousy now, how am I going to feel after the third donation on Monday? I can't take iron supplements so that could be why this isn't going so well. If I give another pint of blood and am therefore more weak, how will I recover well from the surgery? Thanks for any input.

Shell

Susie*Bee
05-14-2008, 03:55 PM
Shell-- I'd suggest telling your surgeon how it's going. It could be that he'd say it's no big deal and just be happy with what you've already been able to give. Then again, he might not. That said, I also will tell you I was able to do it and was still feeling ok for the surgery. Maybe not quite as strong as usual, but ok. I actually gave 4 units in 3 weeks, although I failed the hematocrit the 4th time and had to delay by a couple more days, so it was exactly the one-week deadline for my surgery. (You can't give within a week of your surgery.)

Why is it that you can't take iron? Are you drinking OJ when you eat your iron-rich foods? It helps with iron absorption. There are some brands of blackstrap molasses that can boost your levels also, if you can tolerate that. Molasses is by the pancake syrup in the grocery store. I ended up (the Red Cross nurses suggested it) taking 2 tablespoons of it every night, followed by an orange juice chaser. Ewwwwww! But I survived! :eek: Anyway, at least one kind of blackstrap molasses has 70% of your PDV (percent daily value) of iron. Normal molasses just has 4%... so look at the labels. They ended up using all 4 units of blood--3 during the surgery, even with using the cell saver blood, and then 1 unit when I was in intensive care.

Good luck!!! I'm thinking of you! ;)

amae28
05-14-2008, 04:02 PM
Just a thought but do you have any family that might be willing to try and donate for you? You don't want to be feeling under the weather before your surgery even happens, and if donating is causing problems with your hemoglobin then maybe you should consider it. I am only supposed to donate 2 units, but my mom is going to try and donate one for me so that i only have to do one. I have donated blood before and i know i get really light-headed for a few days... i hope that you can figure something out, if not, call your surgeon--- he might have a better suggestion. Good luck!

Singer
05-14-2008, 04:09 PM
My blood donations took so much out of me I refused to donate for a third time and simply told the surgeon's nurse I was done. They had donor blood on hand for me but as it turns out I only needed the two pints I donated. You don't HAVE to donate if you don't feel up to it.

txmarinemom
05-14-2008, 04:58 PM
... If I feel this lousy now, how am I going to feel after the third donation on Monday?

Shell, I'm with Susie*Bee (talk to your surgeon) and Singer (just say NO!).

Monday (the 19th) is actually beyond the range of generally accepted safe pre-op autologous donations: The rule of thumb is no more than 30 days prior, no less than 10 days prior. Personally, I'd say a THIRD donation Monday is too close - especially in light of your dropping hemoglobin.

Whomever posted about having family/friends donate for you ... yeah, you could. *However*, I don't understand why so many are against blood bank supplies. There is nothing wrong with either banked blood OR cell saver, and there's a good chance you won't need *any* blood transfused - much less 3 pints!

(I banked a pint of my own, and it wasn't necessary during surgery. We only used it a few days afterwards because my counts were a TAD low, and it irritated me that it might go to waste. :-)

At this point, you really need to focus on building yourself UP. You already have 2 pints in stock, and if it were me, I'd call it a day.

You're going to need your energy afterwards to heal, hon ... and going in with your levels skewed is going to hurt you in the long run.

Good luck to you, Shell. I know it's scary, but you're going to be fine.

Regards,
Pam

Susie*Bee
05-14-2008, 05:26 PM
Shell-- the other thing is to be sure to eat well to boost that iron back up, regardless of what your surgeon says about donating. Your hemoglobin (or hematocrit--whichever way they test) will always go down as you give more blood, which is why it dropped for your 2nd time--but it can't drop below a certain level or you can't donate. That's why they make all but autologous donors wait two months between donations. Anyway, even if you don't donate any more blood, you should still work to build up your iron again, so eat plenty of red meat and other foods high in iron... You'll do fine. It's almost time! Try to enjoy your time till the big day-- don't get stressed over the blood donations. :)

txmarinemom
05-14-2008, 05:59 PM
As far as food ...

Green, leafy veggies - the darker the better ... and organ meats. (yes, I realize some are barfing at the thought, but I LOVE liver!)

I still say too close to surgery to spurt another pint, but that's just me.

And continue to drink lots of water (a gallon a day spread out over a day is reasonable) whether you donate again or not. You need it to replace what you've lost.

loves to skate
05-14-2008, 06:18 PM
Hi Shell,
I never was able to donate blood for my surgery as I developed a nasty cold 5 weeks before the surgery date. I got well just in time for the surgery. I required 8 pints between the two surgeries. Two were from the cell saver from the posterior surgery, then three pints a day after. I had three pints after the anterior surgery. I have worked in blood banks for years and because of all the testing and questions on the questionaire for homologous donors, I was not at all afraid of receiving bank blood. A 15.3 hemaglobin dropping to a 12.3 is a big drop. Are you a small person? I would forget about donating any more blood if I were you. You would probably be rejected anyway. Most women are fortunate if they are able to give 2 pints.
Follow the advice about the black strap molasses and OJ if you can tolerate it and eat plenty of red meat. The iron in red meat is most easily absorbed.
We will be thinking of you. Sally

myachingback
05-14-2008, 06:51 PM
It's your body "Just Say No" if you fell you are too weak and as long as you trust the screened blood, (I do). I would rather gather myself and be strong for surgery, I doubt they would cancel over it. I think one surgeon told me I needed to give 3 also, personally I'd rather keep it and have some added if needed!
Good Luck!
Our Very Best To You,
Chris & Cathy

briarrose
05-14-2008, 07:47 PM
Thank you all so much for your invaluable and fast responses. I'm going to call my surgeon tomorrow (I feel like I call every other day. I hope I don't annoy them!). I'm actually waiting on a call from him regarding my nickel allergy which is a whole other issue.

Susie - I'm going to try to find some molasses tomorrow. Thanks for the suggestion!

amae - Getting family members to donate is a good idea. Unfortunately, all of mine are too chicken except for my husband. I don't know my blood type so I don't know if that would work.

Singer - I think I'm going to do the same thing you did, refuse! Thanks!

Pam - Thanks again for your support. I cannot eat liver! I tried twice and it's just too gross for me. I completely lost my appetite after my donation last week which is weird for me. I'm always up for eating. I'm forcing myself to eat 3 meals a day. I bought some spinach today and ate chili for dinner.

Loves to skate - Thanks for your input. If my surgeon insists that I give another pint (I doubt he will), I'm going to hope I get rejected. I'm an average sized person (5'3" 130lbs) who rarely eats meat. I was surprised I was able to give at all so like you said, I should be happy with 2.

Chris and Cathy - I'd prefer to keep the third pint as well. My surgeon originally said 2 pints, but since my surgery was postponed a week, he said why not another. He should be pretty understanding about it.

Thanks again everyone!!!!

Shell

Janet
05-14-2008, 09:25 PM
Shell,

One more vote to not worry about any more donations.

My surgeon told me I would need 4 units, which it turned out I did, in addition to cell saver blood. Being a very stubborn person, I was obsessed about donating 4 units. Turns out, because my veins are very small (even tho I am not), it was very difficult to get the needle in, and once it did get in, the blood stopped flowing soon after; the nurse kept trying other veins in both arms & both entire forearms got badly bruised each time. I went to the blood bank 6 or 7 times, was rejected a few of these because of low hemoglobin, did manage to give a 1/2 unit before the flow stopped (which they had to throw out b/c the bags are set up to hold a whole unit) and once actually gave an entire unit plus extra for specimen testing (it took over an hour for that much blood to flow!). Soon after, I was told my surgery date was being pushed back 3 weeks, which meant this 1 unit would have to be frozen.

Then I got a letter from the blood bank saying that my speciman tested positive for HEP-C, which I knew I didn't have. My PCP ordered more tests and, sure 'nuf, I tested negative for HEP-C. Also, I was told that Hospital for Special Surgery didn't care even if I were HEP-C positive, because it was going back into me. However, turns out HSS does not freeze blood; instead it gets sent to the New York Blood Bank, who decided that because the bag was (incorrectly) labelled "contaminated" they would not freeze it (despite my surgeon's nurse explaining to them that the specimen, not the bag, was what was contaminated. So they threw out my one & only unit!

What of waste of time & energy! I received 4 units of bank blood. A nurse at the local blood bank said she never had a female patient, and only once a male, who was able to give 4 units. She told me, "go home; better to have the blood in you than in a bag"

Susie*Bee
05-15-2008, 12:46 PM
Good for you, Shell. It sounds like you have a good plan, and got some good advice from the group. Now, if only the surgeon goes along... ;)

If you read this before you go shopping--all blackstrap molasses aren't created equal-- the first jar I got was just 20% PDV iron... and I thought the nurse had just remembered wrong. But when I was in another store I checked their brand, and it said 70%. I sort of took it like cough syrup--sticking the spoonfuls in my mouth quickly and trying to swallow immediately. Don't get me wrong-- I love molasses, but when it's baked in stuff. And blackstrap is really strong. :rolleyes:

Janet--the nurses at the Red Cross blood center where I went also said hardly any men can do 4... most peter out at 2, maybe 3. And most women do 1 or 2 at the most. They said they didn't get why these surgeons are always requesting so much blood when it just doesn't happen. I tried so hard with everything I ate, cut way back on caffeine, etc. When I finished and got all 4 units, they called me "Wonder Woman"-- which really buoyed my spirits at the "1 week to go" time... I felt like at least I had succeeded with something! :D I'm sure it's my one and only claim to fame. :o Sorry you got such a raw deal with your valiant efforts. :(

briarrose
05-15-2008, 01:53 PM
Wow Janet, that sounded like quite the ordeal with your blood donation and for nothing! That must've been stressful for you.

Susie - I went to the store today but had no luck finding the right kind of molasses. I may go to a health food store tomorrow. My husband grew up with health fanatic parents so he had to eat black strap molasses all the time. He said it tastes like tar!

My surgeon just called me a few minutes ago. He said that I didn't even have to give the first 2 units if I didn't want to so I don't have to give a third. He said it sounds like I'm anemic at this point so I may end up needing more than 2 units during the surgery. He said if I feel up to it, I should give, but if not it's fine and I should go eat some hamburgers regardless. I love my surgeon. I wish all doctors were like him.

Thanks again for the advice everyone!

Sherie
05-15-2008, 02:32 PM
Shell

Sheena could only donate one unit which she received in the recovery room. We made a point of telling the doctor that we did not want her transfused with off the shelf blood unless it became critical and fortunately, she was able to get by with just her own unit. She came home anemic, 8.4 Hgb but at 6 months, she's back up to 12. She was pretty dizzy and weak for the first few weeks, but since she wasn't up to doing much anyways, it wasn't a big deal. I noticed she was pale for a few months but we gave her iron supplements and iron-rich food during that period. My point is that you can discuss this with your physician and make your wishes clear to him prior to surgery and you will eventually build your blood back up too.

Good luck!

loves to skate
05-15-2008, 02:52 PM
Hi Shell,
I should have said, I also drew blood donors when I worked in the blood bank and the people that donated the most for their surgery generally received more than those who only gave one or two pints, so don't even think about giving another pint. About that spinach, make sure you cook it because the iron isn't as absorbable in the raw form even though it probably tastes better raw for most people. Take good care, Sally

briarrose
05-16-2008, 08:37 AM
Thanks again everyone! I decided to skip out on this last donation. I'm feeling a lot better today, but I still think it would be better to just forget about it. I don't mind receiving donor blood. It sounds safe.

Sherie - Thanks for sharing your experience. It helped me to make my final decision.

Sally - That's really interesting that people who give blood end up needing more for the surgery. Why do they even have us do it? I know that I want to give blood a few times a year now to help out other people with their surgeries.

Pam - Thanks so much for doing all of that research. My doctor did say red meat has the most bioavailability of all foods and even supplements. It's hard for me to eat it though. I didn't realize I would need to cook the spinach. It will probably get slimy. Yuck! I may forget about the molasses too. It sounds so gross. Your info was very helpful and I'm sure others will find it useful as well. Thanks again!

Susie*Bee
05-16-2008, 09:14 AM
Good for you, Shell-- you've got a good plan. :)

Pam--that was good of you to post all that iron info. I had researched it a lot last spring, when I needed it... but of course didn't know about the forum or getting info from anywhere except by weeding through all I could find on the internet. As far as molasses goes-- I'll take blackstrap over cough syrup, if I have to take it as a medicine. ;) I love molasses sugar cookies--and so does my family. They are made with a lighter molasses, mixed with plenty of other ingredients... But I agree, I don't think I'd like it on my food very much. One teacher at school said "YUM!" when I explained I was taking it... she eats it on biscuits, hot cereal, etc. It must be an acquired taste that neither of us has acquired... But still, it was do-able to take it by the spoonful (2 T) each evening, knowing it would help me. And my hematocrit did shoot back up to a donatable level. :D

Sally-- do you really think there's a correlation between amount of blood donated vs. needed, that has to do with being depleted rather than length of surgery and procedures being performed and all? My surgeon was sure I'd need at least 3 or 4 units or more, based on what he was going to be doing. And I did, even with the cell saver blood-- ~500 cc of that. I lost ~1800 cc. during the surgery. Or is it like comparing our surgeries? In the books I read (Wolpert and Neuwirth), most of the surgeries aren't as long (both extent and time-wise) as what many of us go through. So, many spinal fusion surgeries would not be as demanding on our blood supplies. Just wondering out loud here. But that might be why some that only required 2 units only used 2 units, etc. Those surgeries weren't as demanding... :confused:

loves to skate
05-16-2008, 10:25 AM
Good for you Shell. You will be just fine for your surgery. I think that the Dr's order autologous blood donation to help out with chronic shortages in the blood supply. Also, people started to demand it because of fear of bank blood. At that time, it was justifiable because 20 years ago, people were getting HIV and HEP C from blood transfusions. Testing of bank blood is much more extensive now and the questionairs rule out many people who are at risk of having HIV and HEP C that don't even know they are at risk.
Pam, you are a wealth of information, plus being computer literate helps.
Susie, We used to get little old ladies in their 80's coming in to donate blood for total knee surgeries. We almost always ended up rejecting them because either their blood counts were too low or their veins too fragile or they were too anxious about donating, etc. You don't want to go into surgery with your veins destroyed because a nurse or tech had to fish around to try to get blood from delicate veins with a needle the size of a crowbar. Our hospital is a community hospital where mostly general surgery is preformed along with total knees and total hips, and the bloodiest being prostate surgery, so my experience is limited. But generally speaking, if you go into surgery with low blood counts, you will probably get back what you donated plus more and it will take you longer to recover. Scoliosis surgery in my case was a very bloody surgery even though my surgeon is very skilled. So even though I didn't donate, I still needed 8 pints between the two surgeries. They were very long surgeries, 12 hours for the posterior and 7 hours for the anterior. I think you are correct that there is a correlation to the length or the surgery and the amount of blood needed.
I hope I haven't freaked anyone out. Donating is great, just don't let your blood counts get too low. Sally

txmarinemom
05-16-2008, 01:36 PM
Pam--that was good of you to post all that iron info. I had researched it a lot last spring, when I needed it... but of course didn't know about the forum or getting info from anywhere except by weeding through all I could find on the internet. As far as molasses goes-- I'll take blackstrap over cough syrup, if I have to take it as a medicine. ;) ...

Yeah, if I needed it as "medicine", I'd have to choke it down too - LOL. I'm thinking a I might create a new thread that with just that post incase it might be of help to others in the future (title it something like "Boosting Hemoglobin Pre-op") and add some keywords to make it more likely to turn up in search results. All this info we never asked to learn might as well be documented, eh? ;-).


Sally-- do you really think there's a correlation between amount of blood donated vs. needed, that has to do with being depleted rather than length of surgery and procedures being performed and all? ... In the books I read (Wolpert and Neuwirth), most of the surgeries aren't as long (both extent and time-wise) as what many of us go through. ... Just wondering out loud here. ...

I know you addressed this to Sally, but it's an interesting question, and one I don't believe I've seen addressed here before. (and, geez ... I figured we'd covered it ALL - at least once - LOL!)

It seems to me that the closer to surgery you donate, the more likely the amount donated - and subsequently transfused - would be proportional (simply because your body hasn't had time to replenish the amount). In a healthy state, your body rebuilds most blood components pretty quickly: As you know, however, it's 8 weeks to completely restore components *and* volume.

Unless they freeze your pint(s), 30 days (at least as practiced by my doctor for autologous donation) pre-op is the earliest you can donate, and Hanson doesn't like it any closer to surgery than 10 days.

It stands to reason that losing more than a pint pre-op in that 30 day window (so much shorter than the normal donation interval) would almost guarantee you'd need it run back in during/after surgery to compensate for the loss.

My surgery - a "baby fusion" compared to some here - only lasted about 4 hours (if that). I didn't need the pint I donated during surgery (they were able to get by with recycling), but I got it afterwards. According to Hanson, my counts were so ~slightly~ off, if I'd not donated he wouldn't have even considered pulling from banked blood.

It really wouldn't surprise me if my counts were off because I donated about 16 days before surgery. With my size, I'm sure my body was still in deficit. I lost very little blood during surgery, and I think they only emptied my drain line collection twice afterwards.

All THAT considered, I also wouldn't doubt there's a correlation between blood loss/transfusion volume required and length/extent of surgery.

Those of you who've not only endured but thrived after A/P approach surgeries (and in some cases *several* A/P surgeries) have always left me awestruck. I suppose we all do what we must, but I have *such* a hard time even trying to fathom how I'd withstand two surgeries so close together: Just a posterior approach was trying enough.

The severity of the surgery (and "bonus" procedures like thoracoplasty) surely has *some* weight in the likelihood - and estimated/actual volume - of transfusion, IMHO.

That really is an intriguing view, however (that the amount donated is tied to the amount needed afterwards) ... and one that probably has quite a bit of merit. It does seem reasonable to assume some - if not all - of the blood donated pre-op will need to be returned at some point to right the deficit, you know?

Regards,
Pam

Susie*Bee
05-16-2008, 02:17 PM
Here's a little more to muddy the waters... and no, I am not intelligent in this whole area, so I'm just looking and sharing...
(See what you started, Sally?) :eek:

Here's a link to an interesting article on pre-operative autologous donations (PAD):

http://www.uptodate.com/patients/content/topic.do?topicKey=~LSZZIhWGhqlyA5

It includes this statement:
"An additional benefit is that erythropoiesis may be stimulated by repeated phlebotomies, thereby enabling the patient to regenerate hemoglobin at an accelerated rate after surgery."

But it also says: "The overall efficacy of PAD has been evaluated in both randomized trials and cohort studies [1] . A meta-analysis found that patients who underwent PAD were much less likely than controls to receive allogeneic blood (odds ratio 0.17) but were more likely to undergo any transfusion with autologous and/or allogeneic blood (odds ratio 3.0) [2] . The latter effect is due both to a lower hematocrit in patients undergoing PAD and a more liberal transfusion policy with autologous blood."

What I say is "Hey, whatever works for you will be fine!" ;)

txmarinemom
05-16-2008, 03:00 PM
What I say is "Hey, whatever works for you will be fine!" ;)

Agreed. Some will always be hesitant (questioning the safety, religious reasons, etc.) about blood bank transfusions. It's a personal decision.

It doesn't bother me one bit, but unless I have surgery FOR someone (you know ... assuming science figured that out - and 'cause it was SO much fun - LOL!), it isn't my call :).

Pam