Anaemia pre-op question

I know lots of you have experienced anaemia because of heavy bleeding. Do you have to have your anaemia treated before they'll operate?

I'm anaemic because of bleeding fibroids, but what complicates things is the fact that I have a chronic kidney disease which can also cause anaemia. I get labs done every three months, and I have not been anaemic until my last set of labs (done two weeks ago). My nephrologist wants me to start getting weekly injections of Procrit, but the red tape involved means that I am still waiting for approval from the insurance company. God forbid that treatment decisions are between a PATIENT and her DOCTOR!!!!! So while I'm waiting for some insurance bureaucrat to decide if I deserve treatment, my anaemia is going unchecked. Since it takes at least a month for the injections to have any effect, and since it is only a month until my hysterectomy, chances are that I will still be anaemic on my surgery date. Will they still operate?

Thanks for any answers!

Hi EnglishLavender,

I've been anemic for years, which my doctor knows about, but he did not mention having to postpone surgery. I'm assuming they will still do the surgery. I'm having my pre-op appointment on October 21st. I would assume they would tell me before they actually have me come in the next week. How anemic are you and what type of surgery will you have? My doctor told me, with an abdominal hysterectomy, I would lose even less blood than I would with my period. Of course, with my periods, that could still be quite a bit! He told me that with a vaginal hysterectomy, there is usually a little more blood loss.

EnglishLavender,
I believe if you are too anemic they can do a blood transfusion a day or so before surgeryto get iron levels up. If you are concerned about your iron levels or you are feeling weak, tired or dizzy call your DR and ask if you can take an iron supliment until you are approved to get your Procrit shot. Good luck and take care.

I am just beside myself. I have worked myself into such a state that I feel like I'm going to have a stroke any minute.

This whole hysterectomy thing would be easier for me to deal with were it not for the whole kidney thing. My kidneys will never get any better. I can only hope to maintain my health. Everytime I get labs done, I just wait to get sandbagged by some bad news. I'm doing pretty well so far, but this whole anaemia thing has really sandbagged me. I'm severely anaemic with a hemoglobin count of 8.9 (normal being about 12) and a hematocrit level of 26.6% (30% being the minimum ideal for a kidney patient). All of this after years of having normal readings. Of course, the very heavy bleeding I had with my last period (which lasted 6 weeks and was just getting heavier by the day) probably is the culprit, but it is really hard to see where one problem begins and another one ends, you know what I mean?

I did try Repliva (prescribed by the gyn), but the "gastric distress" I experienced was so painful that I spent a day crying in bed. That was after only 4 days. So, I waited until my next appt with the kidney doctor to get some advice, and he was the one who put me on Procrit.

And of course, I wanted to know more about Procrit. So like an idiot, I went to their website, and there was a new BLACK BOX WARNING in the medical information. And of course there was info about side effects, namely DEATH and SERIOUS CARDIOVASCULAR SIDE EFFECTS. ...

"All patients, including patients with chronic kidney failure:

You may get serious heart problems such as heart attack, stroke, heart failure and may die sooner if you are treated with PROCRIT to a hemoglobin lovel above 12 g/dl. You may get blood clots at any time while taking PROCRIT."

Nice, eh?

Now, I have always taken care of myself. I have always eaten right, taken plenty of exercise and have maintained a healthy weight. Like any of that ever mattered...

OK, now I'm just venting. Getting back to the topic at hand, I'm sure that plenty of women are anaemic before a hysterectomy, and I'm sure the surgeons can take care of that. I guess that's what blood transfusions are for. I'm glad to learn that there is generally not much blood loss (I am having a TAH/BSO) compared to other surgeries.

You know what it is...I'm just convinced that someone, somewhere is going to drop the ball. Some doctor is not going to notice some med that I'm taking, or they'll give me something that kidney patients aren't supposed to have. Some stupid little something is going to slip through the net. Like the bowel prep...I have to watch my phosphorus levels, and the stuff I'm going to have apparently has phosphates in it. So I had to ask them go and double check that it's OK for me to take. Stuff like that. I've convinced myself that I'm the only competent person on the planet and that I have to do everyone's thinking for them. It's not that I don't trust my doctors, it's, well, that maybe I don't trust my doctors! LOL! I don't trust anyone at this point. My husband told me that if I would just stay off my feet for a day, the bleeding would probably stop. Now, my husband is very, very smart, but that was the dumbest thing I'd ever heard.

Apologies for rambling, but I just had to get this off my chest. It just seems that lately, each day brings a new sandbag. Each day, something new leaps up to scare me. Doctors are so hard to talk to! They just don't have the time to talk to me, and if I resort to the internet to educate myself, I just find something else to frighten me. I just want some comfort, some reassurance, and I can't find it.

Thanks for listening.

Hi EnglishLavender,

You must be having a horrible time right now! I could feel your frustration as I read your post. One thing to remember is you are your best advocate. I think double-checking with everyone about what medications you are given and procedures you are undergoing is a smart thing. I know it must be exhausting for you. Does your husband go to your appointments with you? Perhaps he could do some of the advocating for you to take some of the pressure off.

I know positive thinking is difficult at a time like this, but it's really essential. But venting is also a great way to relieve stress, so vent away! We're all here for you.

I wish you all the best!

Well, actually, wolf, I asked my husband to contact the insurance company to get approval and the proper documentation showing the approval. He's good at getting people to do things. So I've taken your advice and relegated this little task to him.

This anaemia is more serious than I realized. I guess I just didn't want to think about it, but once I did, I saw just how anaemic I am. I just don't feel very well at the moment. I have no energy to do anything, and I have found that combatting psychological stress, especially over a long period of time, requires stores of energy that I just don't have right now. And when you don't feel well, everything just seems blacker and more sinister.

Thanks for replying, Lisa. I appreciate your time! <<hugs>>

I think the treatment preop depends upon how anemic you are. I was bleeding profusely because of coumadin therapy and was hospitalized from my GYN's office during my "emergency" appointment. (Yeah - words you really don't want to hear from your doctor - OMG you have to go to the hospital right now! ) I received 8 transfusions preop and had a "team" standing by in case of surgery complications. My diagnosis was "severe acute anemia due to massive blood loss." My doc was afraid my very low blood count might cause cardio problems or a stroke while I was under anesthesia, but I wasn;t getting better because of how badly I was bleeding. My risk for bleeding out was greater than the risk for anesthesia! I had 2 more transfusions post op. Then it took 4 more weeks and a lot of iron tablets to raise my hemoglobin to 10.1. Today I am at 11.1. Doc is hoping to get me to 13.

My biggest challenge to recovery hasn't been the surgery at all - it's been the anemia. It's some serious stuff.

My hemoglobin level was at 8.4 when I had my surgery. They had 2 bags of cross-matched blood on hand, but didn't use them. After the surgery, my level went down to 7.6. I had IV fluids and oxygen for my entire hospital stay.

Here's a pamphlet from anemia.org http://www.anemia.org/pdf/mon_Anemia_and_Surgery.pdf
It's for medical professionals, so it's a little technical, but it might help you understand things better.

With the way things are going (or not...), I don't think I will be able to start on Procrit before my surgery (I will be out of town for 10 days between now and then). I know that during my pre-op appt, they will do blood work and will see what my hemoglobin levels are (and they may be better by then now that the bleeding has stopped...who knows?); I'm sure they will have a plan.

Thanks for all of the info. I'm more informed now, but I don't feel much better. It's just all a bit too scary for me right now.