TOPIC:

ok, i'll try not to make this too scrambled. my platelets run in the teens and sometimes 20. i have never treated, ever. i'm going for some dental work, my doctor wanted to give me nplate but i couldnt afford it. so his assistant said do you want to come to the office and get a platelet transfusion. i said i thought they would get eaten up by the time i got to the dentist, she said not necesarilly. i'm confused. i could be in the chair and then the platelets crash.
anyone familiar with this scenario?

thanks

I’ve heard the same as you as far as a platelet transfusion not lasting more than hours but I’m not entirely sure. Have you considered IVIG? I know that they sometimes use this before procedures. It takes a day or two to work and lasts about 1-2 weeks.

I was given platelets when I was diagnosed. I went in at 14k. An hour after the transfusion I was upper 40's. Next morning was back to 24k. Timeline:

ER @ 11:30am: 14k
Transfusion @ 12:00pm
Bloodwork @ 1:30pm: 44k (it was either 44 or 46, but I can't 100% remember exactly)
Bloodwork @ 4:00am next morning: 24k

You had bloods done at 4 o'clock in the morning! Oh my!

The problem with blood transfusions is those platelets will become covered with the antibody just like ones own platelets, so the transfused antibody platelets will be detected and destroyed. That's what I was told.

JJ wrote:

You had bloods done at 4 o'clock in the morning! Oh my!

I was already admitted to the hospital. It was when I was diagnosed. The platelet transfusion was one of the tests to lead them to ITP. I had testing, vitals and monitoring every 4 hours for 3 days straight along with every other scan done so I had stuff all throughout the night. Normal day I don't have that kind of early morning testing. 4 AM was testing so they could get results prior to doctor rounds.

Good heavens what a rigmarole. I was admitted at 10pm with a count of 12 (bloods taken at GP surgery earlier in the day), parted with about 75ml of blood for a multitude if tests, given 45mg of Pred and packed off to bed until morning. Platelet count repeated at 8am and result in by 9am.
Using a platelet transfusion as a diagnosis method is just so wrong.

You are a first in my book sleev-les - I've never heard of anyone who had a platelet transfusion as a test for ITP.
Did they say how that was a test?

I was admitted to the hospital at night w/a count of 11k and dropping. A bone marrow test was done the next day, remember I was diagnosed in 1989, and a hematologist called in & was put on prednisone, after another night in the hospital I was released. Only blood product I've had was in 2002 if I remember right and that was an IV of WinRho after my count crashed due to a tetanus booster.

MelA wrote:

You are a first in my book sleev-les - I've never heard of anyone who had a platelet transfusion as a test for ITP.
Did they say how that was a test?

I was admitted to the hospital at night w/a count of 11k and dropping. A bone marrow test was done the next day, remember I was diagnosed in 1989, and a hematologist called in & was put on prednisone, after another night in the hospital I was released. Only blood product I've had was in 2002 if I remember right and that was an IV of WinRho after my count crashed due to a tetanus booster.

With counts so low, they wanted to give me platelets to make sure I didn't have any dangerous bleeding. They also said they were going to watch them and if they immediately started dropping and none of the other test show anything its ITP. If they stay up, there is a chance it could be something else. This was the first thing they did prior to any additional bloodwork since they didn't know what was going on and wanted safe levels until they figured things out. So I was getting them regardless. Test is the word I'm using to describe is a little easier. I had the bone marrow biopsy, ultra sound on my organs, and blood work to check everything else until it was narrowed down and nothing else found.

To me that indicates practice that is neither evidence based nor protocol compliant.
www.medpagetoday.com/resource-centers/chronic-immune-thrombocytopenia-meeting-challenge/overuse-platelet-transfusions-immune-thrombocytopenia/2374 makes a very interesting read starting with "Despite clear evidence-based guidelines recommending that platelet transfusions in immune thrombocytopenia (ITP) patients be reserved for those experiencing hemorrhagic bleeding or invasive surgery, a 2018 analysis of ITP-associated hospitalizations in the United States demonstrated that two-thirds of platelet transfusions given to ITP patients were not linked with any bleeding episode or surgical procedure. A lack of guideline compliance puts patients at undue risk for transfusion complications, increases the length of hospital stay, and results in higher total hospital costs."

mrsb04 wrote:

To me that indicates practice that is neither evidence based nor protocol compliant.
www.medpagetoday.com/resource-centers/chronic-immune-thrombocytopenia-meeting-challenge/overuse-platelet-transfusions-immune-thrombocytopenia/2374 makes a very interesting read starting with "Despite clear evidence-based guidelines recommending that platelet transfusions in immune thrombocytopenia (ITP) patients be reserved for those experiencing hemorrhagic bleeding or invasive surgery, a 2018 analysis of ITP-associated hospitalizations in the United States demonstrated that two-thirds of platelet transfusions given to ITP patients were not linked with any bleeding episode or surgical procedure. A lack of guideline compliance puts patients at undue risk for transfusion complications, increases the length of hospital stay, and results in higher total hospital costs."

I guess thats why once the Hematologist was reached the Dex was started. He took over instead of the ER staff. Not knowing any differently, I had to go along with the ride.

In you initial post you wrote My Endo got me in touch with a Hematologist and when he saw the results said get to the ER.
I find it quite alarming that a haemo sent you to ER rather than admitting you to a haematology ward.

mrsb04 wrote:

In you initial post you wrote My Endo got me in touch with a Hematologist and when he saw the results said get to the ER.
I find it quite alarming that a haemo sent you to ER rather than admitting you to a haematology ward.

The whole transition was a bit odd to me in the beginning. My Endo had me do my typical bloodwork and she got the results and said my counts were low. I had no idea how to take it and all she said was to contact a hematologist and recommended one which is who I am seeing now. The next morning I called to set up an appointment (at this time they had not seen my bloodwork nor was I a patient with any record). As I got off the phone my Endo called me and said she reached out to the Hematologist and he said to get to the ER. I asked her how low my numbers were and she said 10k. I followed the direction and headed to the ER. As I as there and they finally started getting my info I told them about my path to here and about the Hematologist I was trying to get in to see. By the time the ER got a hold of him, they were already giving me platelets. From that point, they were talking back and forth and he was directing the tests at that point. I was considered outpatient even though I was there for 3 days so I went from the ER to the observation ward. Never was I admitted to a specialty ward.

Hopefully that explains how I got from point A to B. Hard to get all the details in text.

One thing I am doing is getting a new Endo. I feel when the results show how low they are and the paper says "PANIC LOW" she should have had more urgency to her response. I feel that she was negligent in that regard.

mrsb I'm not sure if we have a hematology ward here. After seeing me looking like i'd been beaten in a back alley with a 2x4 my medical doctor sent me to the lab & when he got the blood work back that night he called me and said get to the ER because my platelets were at 11k and dropping. I did go to the ER, they did admit me but it was to a regular floor - there I was given a BMB the next day [what a treat, not!] and a hematologist was called in.

Yeah, I don't think we have a haemotology ward here, either.
Even when I was at my lowest, which I think was 7, I was never told to go to the ER. I was just told to get to the hospital for a WinRho treatment. Only had it the once as it didn't work.

Gosh things in the US seem somewhat disjointed. If my understanding is correct haemo patients are dotted all over the hospital in general wards meaning haemo doctors and nurses constantly moving around locations, not good for infection prevention. What happens to patients with blood cancers are they all over the place too?

Here in our major hospital, we do have an Oncology department. I did all my testing and treatment in what was Clinic 1. I didn't go to the regular blood lab for my blood work.
When I was first diagnosed, I took my list of questions and treatment options to my first appointment with my hema and he went through each of them and explained why it wouldn't work. He never even suggested blood transfusions

There is an oncology dept - depending on the size of the hospital I think maybe cancer patients are on the same floor as surgery? I'm not sure though. I'm a different story since I was diagnosed, treated with prednisone per my PCP & hematologist working with each other, and moved a few weeks later to Tokyo.

Never was it offered or suggested a platelet transfusion - here, Tokyo or Hong Kong.

mrsb04 wrote:

Gosh things in the US seem somewhat disjointed. If my understanding is correct haemo patients are dotted all over the hospital in general wards meaning haemo doctors and nurses constantly moving around locations, not good for infection prevention. What happens to patients with blood cancers are they all over the place too?

Large city hospitals such as those where I live do indeed have cancer wards to which hematology patients are admitted. People with emergent problems who either are or are not under the care of a personal physician present themselves to the ER first. If they have a doctor, he is called to give direction for treatment. If they don't, a house specialist is assigned to them. Then the patient will be assigned a bed in the proper department from there.
Smaller, rural hospitals probably wouldn't have such specialized departments. Sadly, many rural areas don't even have hospitals at all. Those folks would have to travel to a larger metro area to be treated.