| My mother's hemoglobin was down to eight again, | | | | the gerontologist ruled out TIA and said it was a |
| which is confirmation of severe anemia, so her primary | | | | delayed transfusion reaction. This was surprising |
| care physician sent her over to a hematologist to | | | | because in my experience as a nurse I have always |
| receive a blood transfusion. It was all well intended to | | | | believed that blood reactions are usually immediate and |
| avoid another hospitalization. This blood specialist has | | | | if the patient does not react after 2 hours of |
| her practice in a cancer center where they provide all | | | | observation, we don't have to worry about it. |
| kinds of intravenous therapy including blood transfusion, | | | | However, I have come to learn that this standard only |
| so it seemed that an out patient administration of | | | | pertains to compatibility issues. Apparently, there is |
| packed cells made sense. Well, they infused two units | | | | another issue regarding sudden increases in hematocrit, |
| over five hours and sent her home after a two-hour | | | | which alludes to the viscosity (thickness) of the blood. |
| observation. | | | | In my mother's case her hematocrit went up post |
| For the first two days, Mom was fine. Then she | | | | infusion from 26 to 33. This is a problem for the elderly |
| started to become more talkative than usual and grew | | | | because the thicker blood builds up more pressure in |
| progressively more excited over the next 24 hours. By | | | | the capillaries (tiny peripheral blood vessels) and with |
| the end of the third day, she was completely confused | | | | the loss of elasticity in the elderly, pressure can build up |
| and agitated; with a mindset that we had not seen for | | | | in the sensitive brain areas and cause deleterious |
| about thirty years (she is 97). She had no connection | | | | changes in mental status. |
| to the present and did not recognize her live-in | | | | In conclusion, it is clear that the hematologist (blood |
| caretaker who had been with her for six years. The | | | | specialist) was unaware of this risk factor in the elderly |
| situation had become dangerous, hence we called 911 | | | | with the infusion of two units of packed red blood cells |
| and the paramedics took her to the hospital | | | | (PRBC) over only five hours. The gerontologist, |
| emergency room. The initial diagnosis was | | | | however, stated that the standard of care is to infuse |
| trans-ischemic attack (TIA) which is a series of tiny | | | | no more than one unit per day and take a complete |
| hemorrhages (small strokes) in the brain that usually | | | | blood count in between to check the results to |
| produces sudden temporary mental aberrations. | | | | determine if a second unit is even necessary. |
| After a series of tests, i.e. CAT scan, x-rays, labs, etc., | | | | |