First, do no harm!

There is no point treating a chronic condition without making first sure that anemia is taken care of. Anemia is a constant erosion. Would you build your house on sand? Someone affected by chronic anemia is tired and, likely, deals with sleep disturbances. Such person requires copious amounts of caffeine to stay awake during the day and sleeping pills to fall asleep at night – for more about the implications derived from this, read my many posts on caffeine and melatonin. Signs of depression are not unheard of either. Anemia is often accompanied by an irregular heartbeat, dizziness, chest pain, or shortness of breath. Individuals with anemia tend to be pale or yellowish and have cold hands and feet. Any and all of these signs or symptoms should be evaluated carefully if noticed, so a doctor check-up is mandatory. There are many causes of anemia. Unfortunately, some of them are very well covered by our habits and lifestyle, such as coffee drinking, make-up wearing, or riding the elevator instead of taking the stairs. However, be prepared to also witness flat out stupid causes of anemia at times. What do I mean by that? Well, I have a good example that I will always count as a stupid cause of anemia…

A patient everyone liked

I was the pharmacist covering the outpatient leukemia clinic and we had this very caring and kind leukemia patient who was a true pleasure to talk with and treat. In many ways, she was the “ideal patient” for any clinician: sincere, understanding, cooperating, always on time for her appointments, following directions precisely, describing accurate symptoms, etc. Moreover, she always carried her insurance card on her (just kidding about this one!). In any case, as I said: the ideal patient. When you treat such a nice patient and things don’t get better, it hurts you really bad. It feels like the Universe is slapping you back laughing at you: “Ha-ha! You thought it will go the way you wanted? Surprise, it doesn’t!! What are you gone do now?!”. That’s how we felt about this patient when her anemia went out of control with apparently no reason. She responded to the first round of treatment, tolerated very well, her leukemia was under control and everyone was getting ready for the next round of treatment and… she became anemic, then more anemic. We thought we should wait a bit, give her some time to recover before giving her chemotherapy again.

Losing control in leukemia

StopHandOptimizedAs I shared in my previous post, anemia and cancer, most chemotherapy regimens are expected to cause anemia. Many times such effect is so profound that chemotherapy has to be halted because of anemia. Holding treatment is necessary because it would otherwise endanger the life of the patient to an even bigger extent than cancer disease itself would. Most clinicians will recommend holding cancer treatment despite the dramatic risk of cancer spread. So, for the case I’m talking about, you can imagine that her out-of-nowhere anemia was a BIG darn issue. We had to put the cancer treatment on-hold until her red blood cells and hemoglobin/hematocrit levels were deemed “OK” to pursue the treatment. That treatment was going to cause anemia and the whole situation was expected to get worse, but that was the only possibility to continue killing her leukemia cells. Moving on with her treatment or not was a tough decision, but – luckily – her blast count was unchanged. Waters were calm for now. We decided to wait.

A month later

WatchOptimizedHer hemoglobin was now 10 – down from 11.9 last month – no signs or symptoms of bleeding, all checked through and through. She was a very tired looking 58 years old, smiling and excited that she was beating leukemia. Everyone else, however, freaked out like hell! All of us were puzzled and clueless about what in the world was going on. I can tell you for sure that none of the medications she was taking for other health conditions had anything to do with her worsening anemia. There was no history of any other condition that we did not look at either. What the heck?? We decided that each of us is going to sit down and interview the patient, one at a time, with all the questions that went through all our minds until we got to the bottom of it. The direct care of this patient involved one attending, one physician assistant, one nurse practitioner, one social worker, and one pharmacist, each of those with at least one student and/or one fellow and/or one resident. You figured: about ten of us overall!

Popping “the question”

It’s less relevant who popped “the question”, but I still remember that colleague returning to the rounding room with nearly crossed eyes, shrugging and readjusting her shoulders, repositioning her stethoscope around her neck and swallowing for the third time the saliva she didn’t have. Everyone expected a stupid cause of anemia. “So… I asked her if she could think of anything that she did regularly last month that may have caused her to lose blood”. One could tell that a screaming moment was coming. It was imminent and – based on how the story seemed to unveil – this was about to be … very tormented. “She fucking donated blood four times last month!!!”, came the Big-Bang together with a flying stack of papers flying from the door frame all the way to the other side of the desk counter. In a fraction of a second, just everyone else screamed back: “She did WHAT??”. Yeah…, our patieanimalsshockednt was so happy and grateful that she was alive and responded to chemotherapy that she wanted to help others too and decided that donating blood was the best way to show her solidarity with others in need. Oh…my…God! It was hard to point which problem was a bigger: the tremendous delay of her treatment or the risk of someone else receiving her blood. Damn, stupid thing! Why?! It was that kind of moment when yourself suddenly develop arrhythmia, hyperthermia, gastroesophageal reflux, vertigo, and wonder if you need eyeglasses because you can’t focus on what you read any longer. It was a bad day, but with a happy end. Thank God!!!

A good learning lesson

First, do no harm…to yourself! Looking back, at least it makes a good example for a stupid anemia cause. This is one key aspect you need to remember if you suspect anemia: was there any blood loss? That includes intentional or not, as weird as that sounds. If yes, how much and over how long? Yeah, donating blood does count as blood loss… Please tell your doctor that you donated blood when you go for a check-up because it takes some time to make-up the red blood cells that you gave away – 120 days to be more exact!

Remember to share what you learned, my friends, and I will be back with more shortly. Many thanks to those of you emailing me and taking steps toward living beyond 100, your emails are the best motivation ever! Don’t hesitate to click “like” and comment right here as well. Thank you for the time to read, for the trust to take action, and make the change. Your support allowed this website to reach 22 countries on 5 continents – THANK YOU for making this possible!


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Dr. Alice

I teach people how drugs work, when they are needed, and why. My expertise as a pharmacist and researcher allows me to determine whether taking or not taking a drug will pose any risk given all current circumstances that apply at this moment. Many times we don't know unless we try, but other many times walking the extra mile pays off giving in return more wonderful moments and more to give to others.

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