Hematoma

 

Platelet donations have had some recent misadventures.  For a while my hemoglobin did not measure up to their standards.  Lab testing showed iron deficiency, for which I added a multivitamin with 18 mg iron and set up a GI investigation.  A few weeks later, the Blood Bank of Delmarva's desktop hemocytometer displayed my Hb at 14.7 g/dl, which is wrong, as were some of the previous borderline low ones.  It all comes out in the wash.  They prepped me for a donation.  The left antecubital vein has become less of a standout than the right, but still easily accessible for an experienced phlebotomist.  They accessed it, assigning it the afferent arm.  Shortly into the donation it clogged and could not be successfully repositioned.  I was sent home.

Back in less than three weeks for another go.  Due to some elbow pain on squeezing with my left hand, I opted to have the left are as the efferent side to receive the RBC's after the machine extracted the platelets and plasma.  No problem.  Set Netflix to Queer Eye visits Japan.  All systems go.  Felt good squeezing with my right hand.  It seemed to take longer than usual.  With seven minutes to go on the second episode of Queer Eye the TV streaming failed, leaving me alone with my mind and a digital clock that I could see on the far wall.

Like many places, the Blood Bank seemed short-staffed, especially in the cavernous bleeding room divided by the type of donation and the machines required for them.  After checking up on me with less frequency, my last encounter was receiving one of their white blankets as prolonged donations usually leave donors a bit chilled.  My nurse disappeared.  Ordinarily, the collecting machine would signal some type of violation, for which an attendant would check the screen, push a button, and the sound would go off.  No signals, so nobody came by to check me.  I glanced at the bag of collected plasma to my left. It appeared pretty full.  My right hand became sore from squeezing the inflatable ball for so long.  And then my left anterior elbow began to get sore, and then more sore.  The machine finally signalled, bringing the attendant over.  He checked the time, estimated another two minutes, then came back to close off the afferent line.  I mentioned the pain at my left IV site.  He lifted the bandage to find a pretty impressive infiltration hematoma.  I did not really need any more of the few RBC's not already returned, and they weren't going into the antecubital vein anyway, so he shut down the line, removed the needle, called over a more experienced colleague, and applied a compress.  The afferent line was then removed and compressed in the more conventional way, while a freeze gel pack was placed over the injured antecubital fossa.  Pain resolved as soon as the needle was removed.  Swelling took a little longer.  By the time they put the final sterile compress on, the swelling had greatly diminished, discoloration started, and I went on my way to their canteen for coffee and two oatmeal raisin cookies, then home.  And-they gave me a new t-shirt and a discount coupon for a beer at our nearby Two Stones Pub.

Platelets Second Act

 Somebody somewhere should have access soon to my latest contribution of platelets, donated successfully after being disqualified about two weeks ago.  My Hb at the initial presentation measured 12.9 g/dl and at follow-up 13.1 g/dl.  Boundaries can be arbitrary, of little clinical importance but allow important safety procedures to move along efficiently.  It looks like my baseline going forward with be about at the 13 g/dl cutoff.  A little up, they take the donation, a little down I go home and give it a second go in a few weeks.

Usually I schedule early in the day, but for convenience to them, and neutral to me, I accepted an opening at mid-day.  Platelet donors were few but whole blood donors plentiful, leaving a much fuller waiting room and longer check-in than previous morning visits.  My turn arrived, it all went well.  BP remains on target, weight on their scale stable and down from its peak.  Once settled in their recliner, the afferent and efferent lines functioned well, I turned on a mediocre Marco Polo series on Netflix and used it to time actual donation as time in recliner though not time of blood transit.  About 2 hours and 10 minutes.  Since my left hand is still more functional than my right, I opted for that side to squeeze the balloon, making my left wrist painful to extend within a half hour.  By completion, I felt well, just a tinge of transient lightheadedness as I took my first steps, not hypocalcemic but very stiff, struggling to arise from the recliner, walk toward the canteen, or move any joint in either arm.  Over three hours had elapsed since I first walked in the front door, a good deal longer than usual.  Within a few minutes, my arms limbered enough to have a snack.  They no longer leave the snacks at the tables as a form of Covid-19 restriction but a request for a chocolate chip cookie pack and a diet Pepsi was promptly delivered.  

Before the donation, I had made plans to reward myself.  Had I been turned away, I would go to Costco nearby and get my glasses adjusted.  Had the donation been successful, I would go out for breakfast the next morning, something I typically do right before the AM donations.  It was successful, but I don't really have any inclination for the Hollywood Grill which makes better pancakes than I can at home.  I do not know what restrictions they have on dining there and they delayed their usual opening by two hours.  May not be worth the effort.

Sent Home

It was to be a periodic platelet donor morning.  Sleep was restless with one significant interruption, leaving me tired, though two hours in the Blood Bank's recliner, while not exactly snooze catch-up, usually got me to baseline function by my session's conclusion.  Alas, today's session never materialized.

My questionnaire looked good, BP under control, weight a little less than it had been, largely with some minor effort on my part.  The slight downtick on my home scale was probably accurate.  Then the fingerstick Hb.  12.9 g/dl with threshold being 13.0.  Repeat on a finger of the other hand by a different nurse who had rescued my eligibility once before.  11.7 g/dl.  That's probably not right but it's not close to 13 either, so my morning finished about two hours before planned.

I also defer treadmill after platelet donation sessions, so that's now back on tap for later today.  And I spent a little more time at Shop-Rite and got a few more things than I would have had I gone in the afternoon.

Since my Hb has been hovering just over or under their threshold for a few donor sessions, I anticipate that my volunteer days may be approaching the end.  I'll run out the clock a couple of weeks, try to offer another donation, and since I have an appointment with my new doctor at the end of the month, if there is still a concern about anemia, a formal lab CBC can be obtained,

Donating Platelets

Retired people become less useful.  Invitations to offer an opinion on new treatments still come my  way but clicking the Retired Box results in an automatic exclusion.  What I have been able to do more, something highly valuable to anonymous recipients in great need, has been to share my CMV negative platelets to assist some of the chemotherapy patients who often develop thrombocytopenia.  While we now have Granulocyte Colony Stimulating Factor for low leukocyte counts and Epogen to restore red cells, a means of stimulating platelet restoration chemically has been elusive.  Selective transfusion remains a core intervention for recovery. 

While I had been a periodic whole blood donor for many years, prompted mainly by the transfusion insurance a single blood donation once a year would offer my family, once notified that my CMV negative platelets had special value, I made a point of donating four times a year, receiving a 50 donation pin within the past year.  It meant scheduling  this first thing Saturday morning each quarter, for which I would then reward myself with a ride to Lancaster or some other mini-afternoon journey an hour or so away.  This past year, the blood bank expanded to Sunday hours, and with retirement I could go any day.  Rules limit donations to biweekly but so far I've just gone to monthly for the first time. 

Technology has changed.  Traditionally they made the donor into a temporary quadriplegic, tethering me to a recliner with metallic IV's in both antecubial fossae.  I once asked the hematologist in charge, who I knew from my practice, why they needed both arms and metallic access.  Eventually it became a single site for both extraction and return, though the failure rate was much higher and my left hand was a lot more sore that way.  It also seemed to take longer, so after three misadventures I returned to one access to take the blood and the other to return the red cells.  This has worked well.

Incentives have come and gone.  The emergence of Mad Cow Disease and AIDS excluded many potential donors who had potential exposures from living in England to using animal derived insulin for their diabetes.  More people are anticoagulated these days and people take cruises that innocently allow them to stop at a port where the inhabitants might have malaria or Chagas disease.  We also have more people with cancer surviving longer but at the price of toxic treatments.  Thus more need for blood products as the donor pool contracts.  But as long as it is safe for people to get what they need from me, I'm on the list.

They used to offer to screen donors for diabetes with a random glucose taken from the donor plasma or serum.  Rules require eating within three hours so a random glucose in the intermediate range is of limited utility.  RBC collection would allow a hemoglobin A1c which can be drawn randomly but the test is a lot more expensive.  The program stopped a few months back.  For a while my house started to look a little like a Blood Bank Museum with some t-shirt, tote bag, umbrella, or baseball cap either following the donation or by redeeming accumulated points.  That program comes to an end soon.  More disruptive to the blood bank than it's value in enticing donors who usually have a better justification for participating than receiving some kewpie doll with blood bank logo. 

I'm sore, being recently comforted by naproxen once or twice a day for lumbar pain.  In order to donate, this needs to be set aside for three days, and to be sure I usually stop five days in advance.  But the recipient would be in jeopardy without the platelet supply so I can use some icy hot lotion or stretch for a few days.  There's naproxen in the car, first pill resumed on the way home.  And I got my outing and perhaps a small recurrent mitzvah, though it would be unthinkable not to provide this to somebody in need.