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#1
Wed Oct 19, 2016, 02:07 AM
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Transfusing when feverish
My mom is due for a transfusion, but for the past week she has been debilitated with a fever and severe headaches that keep persisting. The nurse said that it's because her hemo is so low, but I think she really did catch some infection, and is still slowly recovering. Is it safe to transfuse in this condition? Her counts are low, so she needs it, but worried about the added stress to her body if still sick.
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Anna, daughter of Raisa age 63; dx MDS 5q- Jan 2013; receiving transfusions, no other treatment, white and platelets stable but Hg dropping; p53 mutation; started taking Revlimid Jan 2017 5mg every other day, Hg went up but since June 2018 has been steadily decreasing 
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#2
Wed Oct 19, 2016, 08:16 AM
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If she needs red cells then I would get them. John had multiple transfusions while fighting infections in the hospital. How high is her fever? The fever should still be addressed by her doc but it shouldn't be a reason not to transfuse. FYI...fevers tend to chew through platelets and red cells so this transfusion may not hold for as long.
The headache is a sign of low red cells and she may need to transfuse sooner. How low is she now?
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Marlene, wife to John DX w/SAA April 2002, Stable partial remission; Treated with High Dose Cytoxan, Johns Hopkins, June 2002. Final phlebotomy 11/2016. As of July 2021 HGB 12.0, WBC 4.70/ANC 3.85, Plts 110K.
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#3
Wed Oct 19, 2016, 01:48 PM
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Not a good idea IMO...
Sometimes transfusions can elevate one's temperature especially if the donated PRBCs are least incompatible.
I use extra strength Tylenol every so often to control elevated temperatures prior to my regular transfusions, in addition to 2x regular Tylenol as part of my pre-meds. 
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Ric: Low-risk MDS (blasts <4%); 4 cycles Revlimid no positive response; PRBC transfusion dependent; so far, 392'units' over 8 3/4 years; BMB #4 (15/04/01) shows evolution to AML (blasts 20-30%  ) 47,XY,del(5) (q22q35),+21[24][cp24]/46,XY(1).
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#4
Thu Oct 20, 2016, 08:18 AM
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The doctor won't allow transfusion if my mother has a fever, Tylenol is given orally and transfusion is done only when temperature is below 99. And at the slowest speed possible. Transfusion itself raises body temperature.
All the best to your mother.
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Mother age 79, dx MDS RCMD low risk del 20q April 2013, no response to EPO, Danazol. pRBC tx dependent - 2 units every 3-4 weeks, exjade Dec 2013 - Mar2014, restarted Dec 2014
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#5
Tue Oct 25, 2016, 10:34 AM
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Thank you everyone for getting back to me! I'm realizing this is more of an art than a science. We did end up transfusing, she was 5.7 Hg, but was still feverish for about four days afterwards. The highest her fever got was 100.2°F. We ended up going into the emergency to see if this was a long standing infection, but we ended up checking out and just seeing her regular doctor. He took blood and we should get the results today, but when I last checked her results I did see that her platelets and white blood count is lower, this is the lowest her platelets have been I think since I've started tracking them, 130, which I know is still quite good, but they plummeted by about 150 in a week. It's good to know that the fever probably lowered them, but I am concerned if perhaps she also has a new mutation. She does feel better now, we will see what the blood results say today or tomorrow, when I spoke with the doctor about Revlimid he was hesitant since her white count are already so low, plus she is hypo-cellular, but said we can try at a low dose, 2.5 mg. Is that enough to even be effective? I'm also starting to consider doing iron chelation, she must be at about 1400 at this point.
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Anna, daughter of Raisa age 63; dx MDS 5q- Jan 2013; receiving transfusions, no other treatment, white and platelets stable but Hg dropping; p53 mutation; started taking Revlimid Jan 2017 5mg every other day, Hg went up but since June 2018 has been steadily decreasing
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#6
Tue Oct 25, 2016, 11:26 AM
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What is your mother's white blood count(WBC)? Also her neutrophils?
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age 70, dx RAEB-2 on 11-26-2013 w/11% blasts. 8 cycles Vidaza 3w/Revlimid. SCT 8/15/2014, relapsed@Day+210 (AML). Now(SCT-Day+1005). Prepping w/ 10 days Dacogen for DLI on 6/9/2017.
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#7
Tue Oct 25, 2016, 04:05 PM
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From the 17th of Oct, wbc count was 1.7, neutrophil was 0.6; Doc said usually wbc counts go up during infection, so not sure what's going on.
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Anna, daughter of Raisa age 63; dx MDS 5q- Jan 2013; receiving transfusions, no other treatment, white and platelets stable but Hg dropping; p53 mutation; started taking Revlimid Jan 2017 5mg every other day, Hg went up but since June 2018 has been steadily decreasing
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#8
Tue Oct 25, 2016, 04:37 PM
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I'm sorry to hear the numbers. I just really have a problem with the "watch and wait" that some doctors suggest. Naturally patients want to go with that suggestion but I am convinced that it is too easy for some doctors to suggest waiting until a person's situation turns for the worse. Having said that, I fully realize there are different forms of MDS and that waiting can be appropriate.
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age 70, dx RAEB-2 on 11-26-2013 w/11% blasts. 8 cycles Vidaza 3w/Revlimid. SCT 8/15/2014, relapsed@Day+210 (AML). Now(SCT-Day+1005). Prepping w/ 10 days Dacogen for DLI on 6/9/2017. Last edited by bailie : Tue Oct 25, 2016 at 05:09 PM.
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#9
Tue Oct 25, 2016, 06:39 PM
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I believe the important thing about watch and wait is the watching! Blood results need to be monitored regularly (I have path 4-weekly). If you can spreadsheet your mum's results so that you can see at a glance whether she's stable or otherwise, that will be very helpful.
If you aren't averse to natural treatments, good quality Olive Leaf Extract and Echinacea may give her neuts and lymphs a boost when she has an infection or virus.
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Dx MDS RAEB 10% blasts + hypogammaglobulinemia, Sep 2011. Jan 2012 BMB - blasts down to 2% w/out treatment so BMT cancelled. Re-diagnosis RCMD. Watch and wait from Feb 2012. IVIg 5-weekly. New diagnosis Oct 2019 AML 23% blasts in marrow, 10% blasts in peripheral blood.
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#10
Wed Oct 26, 2016, 04:21 PM
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Update: as of yesterday, my mom's counts have bounced back up, wbc 2.7 (???) I was so happy, but confused, can they vacillate so much in so little time? And weirdly enough, she still has a low grade fever on and off, highest of about 100.5 F. Doc said if counts are back up then we'll wait and see if the fever tapers off.
Cheryl, yes we incorporate a lot of natural products into her regime, I will try the olive leaf extract. I was reading your byline, so impressed that you got your blasts down. Were you on medication or any other kind of protocol?
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Anna, daughter of Raisa age 63; dx MDS 5q- Jan 2013; receiving transfusions, no other treatment, white and platelets stable but Hg dropping; p53 mutation; started taking Revlimid Jan 2017 5mg every other day, Hg went up but since June 2018 has been steadily decreasing
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#11
Thu Oct 27, 2016, 02:53 AM
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Bananamoore - I will send you a private message.
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Dx MDS RAEB 10% blasts + hypogammaglobulinemia, Sep 2011. Jan 2012 BMB - blasts down to 2% w/out treatment so BMT cancelled. Re-diagnosis RCMD. Watch and wait from Feb 2012. IVIg 5-weekly. New diagnosis Oct 2019 AML 23% blasts in marrow, 10% blasts in peripheral blood.
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