Question about transfusion vs rescue drugs?

[prettydamscared]

Hi all, My husband's NP says that she doesn't typically suggest Procrit.  She says that her patients haven't had good experiences with it.  She said she prefers to transfuse a patient before prescribing a rescue drug.  Hubby did his 5th shot Sat. and told me today that any little exertion is starting to really wipe him out. He had his first bloodwork done at 4 weeks so we'll call tomorrow to get results and find out next step to take but, in the meantime, has anyone heard of having a transfusion instead of Procrit.  Does this make sense?

[Alady1620]

Yes, there is somebody here that has had transfusions.  Maybe he will come along on Tuesday.

[stangshelly]

yes, tranfuse even when on procrit..i took my dad for 3 a week and he was on procrit...he will feel better.

[FlGuy]

I think it's more typical to get procrit aka epo aka aransp than a transfusion. Beagle is the guy who gets transfusions but it's mainly due to another condition worsend by tx.  He hasn't been around for a few days - maybe back in the cyber neighborhgood today.  If hubby needs a 'rescue' now, he'll likely need it again as tx progresses.  Although a transfuse has quicker results (a day or two vs. a couple of weeks) procrit seems to be safe and reliable - many people here have used it and has been a 'tx saver'.  It seems that procrit (with all its names) is much more 'standard' than a transfusion. If it was me and I had a choice - procrit.

[DoubleDose]

Procrit has done the job for MANY of us on the forum.  If your doctor is smart enough to start you early, before the hemoglobin levels dip too low, it will take effect over two to four weeks and keep the red blood cells at higher levels, often allowing for full ribavirin dosing throughout tx.  My concern with relying on transfusions, is that they may need to be done more and more frequently, AND there is always the risk for introducing unknown or undetected pathogens into the recipient.

Procrit use has become pretty standard for many of the HCV doctors with lots of experience in treating the disease.  It can make all the difference in the world in achieving SVR by allowing for the prescribed dosages of Ribavirin, and keeping the patient safe and functional as far as red blood cell counts.

Tiredness and fatigue can also be a typical result of the tx, without always being caused by decreasing red blood cell counts....so monitor the blood counts, rather than assuming that the fatigue is always directly related to hemoglobin.  

Good Luck!!!!

DoubleDose

[Mister beagle bailey]

I'm back in FL.for good!!!!!!!!!

Did shot #24 and have 5 days left of riba.............

Prettydamescared -- I have been on procrit since second week of treatment and have had 2 transfusion.  If not for the procrit I would not have been able to finish treatment.  It was a mircle drug for me and others, I strongly recommend it as do most drs.  Even now, my HGB is 7.6 but it will start to climb when I end the riba Sat. I also brought home with me 5 extra shots of procrit to take to get those #'s up.
Pretty, all drugs have sxs and procrit is no different but it can help you finish tx.  Hope you are doing better.  What is your HGB?

Beagle

[FlGuy]

Welcome back. I'm glad it's almost over for you.  A little recovery time and you'll be running around the neighborhood with the rest of the beagles.  When does NY doc have you getting a FL pcr next?

[friole]

So glad you are back home.  In 5 days you can begin clearing the evil Riba.  What a road, eh?  To a speedy recovery.

[doglover28]

Welcome back and congratulations on finishing up with treatment and returning to the Sunshine State!
Pam

[NYgirl]

I love Procrit - it SAVED my course of treatment literally.  Without it I would not have been able to continue. I've had ZERO problems handling it.

The only reason I've ever seen anybody have a transfusion is because the anemia was so BAD and would not come up high enough. But remember Beagle has Thalessemia and Mauka who's hgb was 3 or something ... they both are very RARE cases.

This is why we always suggest that people check beforehand that a doctor will prescribe the rescue drugs. They are CRUCIAL to our success.

[NYgirl]

PS if you (he) are on Riba you would most likely need a transfusion every week or two...I mean doing it once wont help keep UP the hemoglobin.  I have been on Epogen since like week 3 or 4 and am now on week 38 - 40 somewhere. I plan on staying on it the entire course of tx otherwise I start to drop again rapidly...and I never, ever want to go THERE again.  Yuck.

[friole]

I think the problem with transfusion is that they are not going to do it until your hgb is about 7.  Believe you me,the weeks he drops from 10-7 your hubby will be laying flat.  Procrit helps keep it level all during tx whereas, with the transfusions, I think he would be suffering needlessly for long periods of time.

My HGB yesterday was 10.9.  The hemotologist nurse and I talked about whether I should do two shots this week, and I said no, but if it is in the 10s next week I will do two.  She said I really am not taking that much (40,000 units once a week).  I guess that means chemotherapy patients take lots more.
frijole

[prettydamscared]

Thanks for all your answers.  NY Girl, is Epogen basically the same thing as Procrit?  So, prescribing Procrit is for rapidly dropping red blood cells, which is the same thing as hemoglobin, as opposed to white blood cell count.  Is that correct?  I think I had it backwards.

[DoubleDose]

You are correct, the Procrit (or Epogen) is for hemoglobin or red blood cells.  When they get too low your body becomes depleted of oxygenation, and extreme fatigue and anemia set in.  The Procrit will generally prevent these problems.  I did two shots a week for the better part of 72 weeks.

The white blood cell issues can be addressed by other drugs, and when too low allow one to be subject to infection more easily, and less able to fight infection successfully.  I have never seen much in the way of real problems from this issue, and had pretty low white cell counts throughout tx, with no real consequence.  

The red blood cell issues are felt more dramatically, and are often more dangerous is left to decline without intervention.  Although I spent most of tx between 8.5 and 10.5 even WITH the Procrit.  Can you imaging what would have happened if I had not used Procrit???

DoubleDose

[DoubleDose]

You are correct, the Procrit (or Epogen) is for hemoglobin or red blood cells.  When they get too low your body becomes depleted of oxygenation, and extreme fatigue and anemia set in.  The Procrit will generally prevent these problems.  I did two shots a week for the better part of 72 weeks.

The white blood cell issues can be addressed by other drugs, and when too low allow one to be subject to infection more easily, and less able to fight infection successfully.  I have never seen much in the way of real problems from this issue, and had pretty low white cell counts throughout tx, with no real consequence.  

The red blood cell issues are felt more dramatically, and are often more dangerous is left to decline without intervention.  Although I spent most of tx between 8.5 and 10.5 even WITH the Procrit.  Can you imaging what would have happened if I had not used Procrit???

DoubleDose

[FlGuy]

epoetin alpha, Epogen and Procrit are all names for erythropoietin and are used for red cell growth and sometimes called EPO.  There is another, Aranesp,  which is related to the other three and used for the same purpose.  Neupogen and Neulasta are filgrastim (Neulasta being a pegylateed version of neupogen) and are use to stimulate the production of white cells. To over simplify, the former is used to treat anemia and the later to treat low wbc, specifically low Neutrophils.

[NYgirl]

I remember reading this when looking up aransp when I was wondering why a this new miracle drug existed and I didn't nkow.  Then I got home to take my Epo and it said erytho however you spell that right on the box and I was like oh DOH no wonder it all looked so familiar to me!

I've been hovering around 10 since forever (actually since I went up from 9 to 15 and then went on once a week Epo).  I can't IMAGINE what it ...8...7 is too low.

[MissMiss]

Since we're talking about Procrit I thought I would throw my experience in here.

I have been taking 80 a week in one shot for what seems forever.  My HGB is hanging in the low 9's, started at 15 and low of 8.9. HCT is hanging around 28.  NP and doc are surprised HGB isn't coming up with the high dose and even called to make sure I was doing it.  

This week I am splitting it into two shots of 40 just to see if it helps raise HGB.  The bone pain with 80 is pretty severe, although some say Neup cause more pain.  I dunno but this week it doesn't seem to be quite as bad, even with 300 Neup.  Legs are just rubbery but not as painful.

I do have concerns about lasting effects of both Neup and Procrit after treatment and only time will tell.  

May you all have a great day!

miss

[prettydamscared]

Thanks everyone for all your replies.  We finally got the results of his 4 week blood work today and his NP said all tests were normal, which means that his fatigue isn't due to low rbc count but just a sx of the treatment.  I personally would have gotten a copy of the test but he didn't and he also won't ask for a prescription for Procrit, just in case.  THe NP said should his rbc count drop, they'd transfuse, so he's not even questioning that.  He actually kind of scoffed at me today and asked who was I going to believe, people on the internet or the NP.  I said the people online, of course.  Oh well.................

[sfbaygirl]

John and I have had "the talk" quite a few times but it keeps coming back up. I have a gorney high! I sure hope it improves as my roller coaster sx are stablized. I thought things seemed better yesterday and then bamm my fingers, bones even my hair aches today! This is NOT my scheduled day for that to happen damn it!

I think he worries so much about me that he thinks he is doing everything for me. I don't ask for much, if anything. No appetite either.  Yesterday he was upset that he felt like an errand boy when I asked for a glass of milk. This was the first I asked anything for a few days at least. It's hard on our loved ones, I know this. i wish there was a forum for spouses to commiserate. Know any? Sometimes he asks me about a forum, as he sees how much I get out of mine. He has read this one, but knows most of us are on tx and that is not what he wants.

My next jumanji roll is going to be no sx and big time sex drive! This has to get better with some rolls. I know some of these days have to be better than others.