Transplant Digest - Fall 2010, Issue No. 9 - St. Michael's Hospital

More documents

Recommendations

Info

Post-Transplant Chat Thelma Carino, RN, Jennie Huckle, RN and Fernanda Shamy, RN POST-TRANSPLANT ANEMIA 1. What is anemia Is it bad Anemia is defined as a hemoglobin level less than 135 g/L in men and 120 g/L in women, on the basis of blood testing. It is not a single disease, but rather an effect from one or more of a number of processes. Anemia is bad because it can cause fatigue and breathlessness, and can cause heart damage. Patients with major illnesses who also have anemia tend to do worse than those without anemia. 2. How can you tell if I have anemia You may feel very tired or weak, feel your heart beating faster, and feel breathless or cold. Your nails may lose their natural pinkness, and your mucous membranes (especially the inner part of your lower eyelid) may look very pale. Most commonly anemia is detected by blood testing, before and after your transplant. Usually the compete blood count (CBC) in a lavender-top blood tube is checked regularly, but sometimes blood iron stores, folate and vitamin B12 are also ordered. 3. Why do I have anemia Almost all patients with chronic kidney disease have anemia, because a hormone called erythropoietin normally made by the kidneys which tells the bone marrow to make blood, is no longer produced. If your kidney transplant also does not make enough of this hormone you may have anemia. Unfortunately some of your anti-rejection drugs and blood pressure lowering drugs which you need can also contribute. You may be deficient in essential nutrients like iron, folic acid, and vitamin B12. You could also have an infection which makes it difficult for your body to use these nutrients properly. Another important cause is blood loss, such as from heavy menstrual bleeding or bleeding from your stomach or bowels. Sometimes diseases in other organs like the liver or thyroid can also cause anemia. Rarely, you may be breaking down blood cells in your bloodstream as a result of certain diseases or drug reactions. Routine blood testing, even if frequent, is not usually a cause. Anemia is normal and to be expected in pregnancy. It is usually hard to find a single explanation for anemia. 4. I used to have anemia on dialysis. Will I still have it after my transplant Some patients continue to have anemia after their transplant due to one or more of the causes listed above. More commonly however it corrects on its own if the transplant is working well. This may take a few months. 5. Will fixing anemia solve all my problems No, unless your symptoms were strictly due to anemia. This is rarely the case. Years of chronic kidney disease take their toll on the body, so while fixing anemia may solve some aspects of your health situation, it certainly does not solve everything. 6. Can anemia be improved by diet How about a multivitamin It certainly helps to eat nutritious food. Your body normally absorbs about 10% of the 10-15 mg of iron present in a normal diet, and keeps iron balance by losing and absorbing 1 mg per day. Iron rich foods include liver 4
and lean red meats, seafood, various kinds of beans including soybeans, iron-fortified whole grains including cereals, pasta, and breads, spinach and green leafy vegetables, broccoli, asparagus, and Brussels sprouts. If you are vegetarian, you do not have to become a meat-eater to get more iron! Good sources of folic acid include dark green, leafy vegetables, whole wheat bread, beans, peas, nuts and seeds, sprouts, oranges, liver and other organ meats, and fortified cereals. Vitamin B12 is richly present in meat and seafood, cheese and eggs. Those who consume no meat or dairy products probably need to take a supplement. Please check with the transplant clinic before taking any multivitamins. 7. Are there medications which can be used to treat anemia Sometimes medication becomes necessary. If you are taking an iron supplement, do not stop it without discussing this at a clinic visit, because your hemoglobin may suddenly “crash”. If you have stomach upset from an iron tablet, check with our pharmacist who may be able to find another formulation more suited to you. Do not take iron at the same time as calcium. Do not panic if your stool becomes black with an iron supplement. Sometimes taking vitamin C along with iron allows it to be absorbed better. Very rarely, intravenous iron can be given in the hospital. If you have been prescribed folate tablets or vitamin B12 injections, please do not stop taking them on your own. Rarely, your transplant doctor may decide to change or adjust your transplant drugs or blood pressure drugs to try to help your body correct the anemia. Finally, you may be asked to take injections of erythropoietin or darbopoeitin. 8. I have been told to take injections for my anemia. I am nervous about this. If you took these injections by yourself before the transplant, it will be no different afterwards. If this is your first time, bring the injection with you back to the transplant clinic as soon as you have filled the prescription and one of the staff will show you how to inject under the skin. Get a family member involved if needed. Remember, you can fill your injection only at one pharmacy because it involves special paperwork. Always keep the syringes stored at the proper temperature so the medication does not get spoiled. 9. Why isn’t my hemoglobin coming back to normal even though I am taking medication for this Whenever you start an injection or have the dose changed, your hemoglobin should be repeated in 2 weeks. Often medication adjustment is all that is needed to achieve correction in a few months. Make sure that you are taking your other medications properly, and are eating a proper diet. If the anemia persists, your doctor may choose to refer you to another specialist, such as a hematologist or gastroenterologist. Every attempt is made to avoid blood transfusions. Remember, with injections your target hemoglobin is only 110-120 g/L. Overcorrecting this into what is the “normal” range for normal people may actually be very harmful. 10. I have been told that my hemoglobin is high. This is not anemia, is it This rare but we do see this. It is called erythrocytosis. The hemoglobin may go up to as high as 200 g/L. No one knows for sure why this happens but it may be related in some way to the transplant drugs. If this is the case, you may have to come to the clinic so that some blood can be removed (it is useless for donation purposes). Some blood pressure drugs like ACE inhibitors or angiotensin II receptor anatagonists, which can sometimes contribute to anemia, may actually be very useful in this situation. 5
Page 1 and 2: edside. Fall , I sue No. • infect
Page 3: (con’t from page 1) parathyroid h
Page 7 and 8: more aggressive. Age, sun exposure
Page 9 and 10: An Introduction to Diabetes and Kid
Page 11 and 12: NOTES

Transplant Digest - Fall 2010, Issue No. 9 - St. Michael's Hospital

Create successful ePaper yourself

Delete template?

Save as template?