Type and (double) Cross

Good afternoon all:

Just writing while getting the last of what has seemed to be an endless stream of transfusions. The platelets and red blood cells continue to dip and I alternately make and lose white blood cells. I still have no immune system to speak of, so the risk of infection continues for me.

I have been able to get to Nolan's baseball games which has been fun. I even found a way to position myself at one of the fields so as to be away from everyone and still in a prime spot to 'coach'. That was quite enjoyable.

The appointments at Hopkins this week were both longer and more frequent than is typical. My appointments are routinely scheduled for 10:30 and I had appointments this week on Monday, Wednesday, Thursday, and now Friday. They have been trying to get me on an every-other-day schedule but this week it proved difficult. And if I have anyone or anything to blame it is the "Type and Cross".

The "Type and Cross" is a blood test that they perform every so often. It serves as a double check on your blood type so that if/when you need blood products (platelets, red blood cells in my case) they have done what they can to verify that they are giving you the correct blood type--very important. Two things have always struck me as odd regarding the 'Type and Cross'. First, the results take significantly longer to process than any of the rest of the tests that get routinely run. I can't figure out why this is. I can remember testing my blood type in a science lab in High School (or maybe it was college). This was accomplished during normal class time and without fancy gadgetry. How is it that what I could accomplish (accurately, I might add) within a one hour period as a half-interested student, takes an organization like Johns Hopkins with all the technology, the best people, 3 or more hours to complete.

The second conundrum with the 'Type and Cross' is that its results are only good for a few days. After so many days have elapsed the blood bank will act as if they do not know what my blood type is and refuse to issue me blood products until a "Type and Cross" is performed. During my first go-around with chemotherapy I learned that the reason behind this is that individuals who get a bone marrow transplant (as I am) may well come away with a different blood type--that of their donor to be precise. Of course I was wondering what that information wasn't in a database somewhere.

The time cost of having your "Type and Cross" elapse is easily two hours and is more likley to be three or more hours under certain circumstances This is a lesson one learns quickly and during my first stint with the clinic I soon learned to keep track of when my last "Type and Cross" was and to press for one if I thought it was set to expire.

But, time has elapsed and it does not seem that all the tricks came back to me.

I was transfused Monday with platelets and red blood cells and was told that I could skip coming in on Tuesday The process took forever because the blood products could not be issued until a 'Type and Cross" had been completed. When I came in on Wednesday it turned out that I hadn't dropped enough to warrant transfusions and was sent home once the blood test results were known--a pleasant surprise. Before I left, the nurse astutely grabbed a late "Type and Cross" blood sample so that it would be analyzed and my records updated for when I came in next--the original plan was for Friday. But two things happened.

First, the logic of sending me home without a transfusion was fine, but my counts would not be at acceptable levels for 48 hours. As a result I received a call on the way home on Monday telling me that I'd have an appointment on Thursday with the goal of giving me the neceessary transfustions to allow me to skip coming in on Friday. Second, as I learned when I returned to the clinic on Thursday, an error was made on the ordering instructions contained on the label on the vial of blood for the "Type and Cross". As a result the test was halted and my "Type and Cross" data was now out of date.

So, the "Type and Cross" had to be ordered when I came in Thursday morning. Another delay followed by significant transfusions. It is hard to imagine that one can get tired sitting in a hospital bed all day but I will tell you that I feel exhausted after spending 6, or 7, or 8 hours sitting around at Hopkins sandwiched between a reasonable amount of car travel just to get there. And then to learn that the platelet transfusion (they take a post-transfusion blood test to guage the results) hadn't been terribly effective and that I would need to return on Friday for more platelets and red blood cells anyway . . .sigh. I have now re-learned my earlier lesson: never let the "Type and Cross" elapse--I'll add that to my mental checklist of things to monitor while I am in the clinic.

I know most would agree that my 'job' right now is to get better. I think I'm off to a good start, actually. I just wish that this job didn't come with days like these. It's been a long week and I'm hoping that I'll be able to get some 'time off' this weekend.

As always, thanks for reading.

--Russ.