Posts Tagged with Hemoglobin

The Two-Week Platelet Check

Treatment
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This morning I had a 10AM appointment with the hematologist. As per usual, the nurse began by drawing blood – two vials – and putting me in an exam room to wait for my turn with the doctor. The doctor started by saying that he intends to disregard the LabCorp results from last week. He said blood should be tested as quickly as possible otherwise it has time to pool and clot, which depletes the platelet count. Since the LabCorp in Saratoga had to send the vial to NJ for testing, the sample was likely compromised.

Today’s hemoglobin held steady at 11.5 and the hematologist said he considers my RBC problem resolved and in remission! Obviously the number will still be monitored as I taper off the steroids but he seems very confident that it will stay at 11.0 or higher and that will be my version of “normal”. The hematologist said that, unfortunately, until I’m off the Prednisone, he won’t know what my “normal” platelet count will be. My guess is somewhere between 60 & 80, but I honestly have no idea. People with ITP are known to have a lower platelet count than the average human, but where exactly that count falls is different in each individual. Some people hover around 20 as their version of normal, but I’m hoping my normal will be a higher, safer number. Time will tell!

Today’s count was 96, so if we ignore last week’s skewed results and look at the bigger picture, my count Monday the 27th after 3 days of IVIG was 159 and my count two weeks later on the 11th was 96. My count only dropped 63,000 over two weeks – I don’t think that’s too bad! Going forward, as long as it drops at a slower rate or stabilizes completely, I should be fine! I have a good feeling about this! Maybe I’ll be completely off the Prednisone by the end of the summer and I won’t require any further treatment! That would be ideal!

The doctor’s plan is to taper the Prednisone about 20% at a time. That means the taper that starts tomorrow should technically be 60 mg but they don’t make pills in that dosage so he’s tapering me to 50 mg. Here’s to hoping for little to no side effects.  Since the first taper and the IVIG occured simultaneously, it was hard to tell which side effects were due to the treatment and which were due to the lower dose of steroids.

When I was asking the doctor my questions today I happened to mention my frequent heart palpitations, shortness of breath, and inability to exert myself (walk up the stairs, shower, put on pants, etc.). Originally, a few weeks back, when I expressed this same concern, he said it was due to the Prednisone, which can make patients feel anxious and jittery. When he found out today that my frequency of episodes had increased to daily or twice a day, despite the decreased dose of steroids, he became a little concerned. He said that shouldn’t be happening – the episodes shouldn’t be that frequent and they should have decreased when the dose did. As a precaution, he is sending me for an echocardiogram (an ultrasound of my heart). I know it’s just to double check that everything is okay with my heart, but I’m still a little nervous – not for the procedure, but for the results.

The only thing that has been keeping me sane these last six weeks is knowing that my condition had nothing to do with my weight. It’s unrelated to my bad eating habits, my lack of exercise, or the extra pounds I’m carrying around. Knowing that Evan’s Syndrome has literally nothing to do with outside forces and is completely random and unable to be prevented would probably worry and terrify most people. But me? It makes me feel relieved – relieved knowing that I couldn’t have done anything to stop this from happening. I couldn’t have prevented Evan’s Syndrome by eating more vegetables or running or weight lifting. I would much rather “fate” be to blame. That gives me peace of mind in a twisted way.

That is also why this ultrasound is so terrifying. It reopens the possibility that I am the enemy. I am petrified they will find something wrong – a murmur, heart disease, heart failure, etc. – and will determine the cause to be weight-related. I was fine with these episodes happening when I could chalk it up to the Prednisone, but if suddenly I have to face the reality that my habits and way of life caused these symptoms, I might lose my mind.

The Post-Treatment Blood Draw

Hematology, Remission
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My IVIG treatments finished on Monday, June 27th and my one-week blood draw was this past Tuesday, July 5th. I called my hematologist’s office yesterday morning and they had the results of the CBC from LabCorp already. To my surprise, my hemoglobin went up to 11.6! Even though my Prednisone was decreased to 75mg, my hemoglobin went up…? Can that really be true?! Ecstatic doesn’t even begin to cover it. The hemolytic anemia was, originally, the worse of the two problems. It was the AIHA that caused my jaundice and elevated bilirubin and landed me in the hospital in May. I am VERY excited that the AIHA is essentially in remission at this point. It will still need to be monitored as I continue to taper off the steroids, but I am no longer worried about it.

My platelets, on the other hand, plummeted again. My last platelet count was 159, which was great considering 150-450 is considered the normal range. Fast forward to this week and my platelet count was 62. In case you don’t feel like doing the math, my platelets dropped 97,000 in eight days. That’s not ideal. I had read that the problem with IVIG is that it is often a quick fix, but a lot of times doesn’t work long term. The infusions are meant to give you a large boost in platelet count, but then it is up to your body to continue producing platelets and to know not to kill off the good ones. I think if there was an underlying cause to my low platelets, such as alcohol consumption, drugs, etc., IVIG and abstaining from the problem substance would have been enough to fix it. Take away the problem – take away the destruction. Then it simply would have been a matter of infusing the platelets and PRESTO! Since my problem is ITP, which, by definition, is an autoimmune disease focused on platelet destruction with no underlying cause, my treatment options are more trial and error. The infusions worked to boost my platelets, but my antibodies are still latching on to these platelets and marking them for destruction. Until/unless my immune system can begin to recognize its own healthy platelets again, I’m not super confident my numbers will ever be under control. It seems ITP is going to require constant maintenance.

The thing that I find really frustrating is that, of the two autoimmune diseases that comprise Evan’s Syndrome, ITP is the one that is harder to recognize or diagnose. With AIHA, I felt sick and miserable and tired and weak. With ITP, I just bruise easily. I don’t feel sick, I don’t feel broken or weak, and yet, I’m undergoing long treatments and being kept home from work. I know I’ve said it before, but it is so hard to grasp the concept that I’m sick but don’t feel sick. The idea that my body is destroying itself without any indication is frightening. How am I ever going to know if my platelets are low without a blood draw? I won’t. At least with AIHA, there is a chance I will be able to notice when something is wrong (to some extent). I’m afraid with ITP that I’ll never know there’s a problem until it’s too late.

When I see the doctor Monday I find out what comes next. He’s probably going to recommend a bone marrow biopsy (no, thank you) or another round of IVIG infusions (not loving that idea either). Hopefully he doesn’t immediately jump to Rituxan (the chemo-like treatment). If I had to guess, I’d say it’s likely that there is more IVIG in my near future, but maybe he’ll try a different route considering the reaction/side effects I had by the final treatment. Maybe he’ll say 62 is a safe enough number and he will hold off on any additional treatments and let me wait it out to see if the number holds!  Either way, at least half of the ES is under control and responding to treatment the way it should be. One down, one to go!

The Third Treatment

Treatment
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When I woke up this morning, I immediately noticed that yesterday’s infusion spot was bruised/discolored, warm to the touch, and swollen.  Also, I was short of breath, so I was a little nervous that my hemoglobin levels had dropped again, but this morning’s blood work showed my hemoglobin was back up to 11.0.  I’m almost at a “normal” level!  I showed the bruise to the nurses and told them about the shortness of breath I had been feeling and they determined it was merely a reaction to yesterday’s infusion.

The nurse this morning chose a vein on my left forearm for my blood draw and IV.  She drew three vials in order to run a full CBC, as per the doctor’s instructions.  The results showed that after only two days of the IVIG treatments my platelets were up to 59,000!  That is the highest my platelets have been in months and I’m only halfway through my infusions!!!  After the blood draw, the nurse started the IV fluids and I felt an immediate sharp, stabbing pain in my arm.  It turns out the vein blew up.  It isn’t dangerous, but it means the nurse had to immediately remove the IV and find a new vein for the day.  The blown vein is something I hope to never have to endure again – it continued to throb for a half hour or so.

The nurse chose a vein in my right forearm, so I had to keep my arm facing up most of the day, but it wasn’t so bad.  The Benadryl burned a little when it went through the IV today, but I think I was still just on edge from the blown vein.  Between the swollen green bruise on the back of my forearm from yesterday’s infusion site, the blown vein in my left forearm, and the needle marks and petechiae covering both elbows, I feel like a human pincushion.

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I just pray that some of these heal by Monday because I am running out of good veins.

The doctor wasn’t in today and I still needed to ask about this weekend’s Prednisone dosage, so I had to speak with the on-call hematologist.  I explained that I’d been on the 100 mg dose for a month and was worried that taking no steroids at all over the weekend would cause withdrawal.  She completely agreed and told me to take 80 mg Saturday and 80 mg on Sunday and then my doctor would likely decrease my dosage to 60 mg on Monday.  Since the pills I have are 50 mg pills, she said I could simply take one and a half each day (75 mg).  Easy-peasy!  I’m not so sure I’ll be ready to decrease to 60 mg on Monday, but I’ll worry about that when the time comes.

Today was a slow day at the hematology center.  For the first time all week, I was surrounded by patients that wanted to talk, but another patient was talking loudly on her phone right next to my face the entire time she was being transfused.  It was extremely rude and frustrating.  Taking a quick phone call is one thing, but talking loudly over a TV and other patients trying to converse is annoying as hell.  SHH. Thankfully, she was just receiving iron so her transfusion only took about a half hour.  It was refreshing to talk to other patients afterwards about their conditions and treatments.  I felt less alone.

Apparently the office closes early on Fridays and the nurses and doctors can leave as soon as their appointments are done.  By 1:30 I was the only patient left for the day, so the nurse had to stay another two hours just for me.  The room felt sad and lonely with me in the corner surrounded by empty recliners, but I was able to watch Netflix on my laptop.  I threw on “House” and curled up with a blankie and some snacks.

10:45 AM – 11:55 AM : Vial 1 : 1 hr, 10 mins
11:55 AM – 1:05 PM : Vial 2 : 1 hr, 10 mins
1:05 PM – 2:10 PM : Vial 3 : 1 hr, 5 mins
2:10 PM – 3:05 PM : Vial 4 : 1 hr, 5 mins
Total time required for IVIG treatment : 4 hrs, 30 mins

My husband picked me up around 3:30 PM and we headed back to our apartment.  I had a little bit of a headache, but nothing like yesterday’s.  The only difference between Wednesday/today and Thursday was the time of day the Solu-Medrol was administered.  I am inclined to believe that yesterday’s side effects were due to receiving the steroids in the afternoon, rather than the morning.  I’ll make sure to ask for them first thing on Monday.

The Game Plan

Treatment
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I spoke too soon… treatment will begin tomorrow (Wednesday) at 10:00 AM.  I will be at the hematology center for 5-6 hours a day Wednesday, Thursday, Friday, & Monday.  On Friday the doctor will check my platelet count to make sure the treatment is working.  From what I understand, the IVIG is meant to give a quick boost to my platelets and my numbers should skyrocket.

When I called the hematology office this morning to see if I would be starting treatment today, I was sure to describe my spontaneous bruising.  The doctor had his staff call  me around 1:00 to come in for blood work.  My hemoglobin was up to 11.1!  The steroids definitely seem to be working for the RBCs!  My platelets, however, were down to 22,000.  They dropped 9,000 in five days.  Once I noticed the spontaneous bruising, I had a feeling they had dropped, so I’m not all that surprised. The doctor said that since I’m starting IVIG in less than 24 hours he’s not concerned about the drop, but that if any of the following occur I should go straight to the ER:

  • A large unexplained bruise
  • Bleeding from the gums
  • Nose bleed

After IVIG ends on Monday, the doctor is likely to schedule an appointment with me for Tuesday or Wednesday to check my counts and start tapering me off the steroids.  I am a little nervous about my numbers dropping once I start tapering off the Prednisone, but the side effects are becoming a nuisance and I can’t stay on the medication long-term. The best case scenario here would be a very successful IVIG treatment, 2-3 weeks of tapering off the steroids and getting regular blood draws, and then remission!  If my numbers hold steady as I taper off, I should definitely be set for a while!   Maybe then blood draws will only be once a week or once a month!  Say a prayer that this course of treatment is going to do the trick!

The New Hematologist

Hematology, Treatment
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I decided on Thursday evening, after my rude encounter with the staff at the hematology office, that I needed to find a new hematologist.  I know I am going to need to see this specialist for a very long time and I refuse to settle.  I want a doctor I can trust.  Thankfully, I found that today.

I called the old doctor’s office this morning around 10:30 hoping to get my numbers from last week so I could share them with the new doctor. The receptionist said “oh. Nobody called you?!” and then proceeded to tell me the results were finalized yesterday and I needed to come in right away because my platelets weren’t responding to the steroids. At this point I was fed up so I said I’d call back to schedule an appointment. My hemoglobin was up to 10.4 from 8.7, but my platelets had only gone from 41 to 44. These results were a week old at this point and I was just finding out about them. This only served to solidify my decision to switch hematologists. 

I worked from home today because I had an appointment with my new hematologist at 11:30.  The office was easy to find and spacious. I filled out some paperwork and was taken in the back around 11:50 to have my blood drawn and my vitals recorded. The nurse took three vials of blood and immediately ran one through a machine that spit out a reading in less than five minutes!  Do you know how amazing it was after the fiasco with my original doctor to know my numbers before leaving the office?    

By the time the doctor met with me, he already had my counts.  My hemoglobin dropped ever so slightly to 10.2. This drop wasn’t that worrisome or significant, but the steroids should have at least kept my numbers stable. He then explained my condition to me and discussed that yes, figuring out a treatment plan is important, but so is taking ten steps back to figure out why this condition started in the first place. Until we know what caused it, it’s very hard to stop it. He then got very serious and said “you might want to conference in your husband for this part”. He proceeded to tell me that my platelet count was at 13. 13?!  How did it drop by 31,000 in one week?  Seven days?!  The thing that REALLY concerned him and, in turn, frightened me is that the number was able to drop so much and so low while on high dose steroids that were meant to do the exact opposite. 

Because of my dangerously low count – at 10 and under some people start spontaneously bleeding internally without any cause or underlying injury – he said the first step was to send me to Jersey City Medical Center for an immediate outpatient platelet transfusion. By the time the hospital finished registering me it was past 3:00. The infusion center drew my blood to send to the lab for cross matching. I couldn’t get platelets until I had been matched. Matching takes the lab about an hour and then the transfusion takes about an hour as well. Unfortunately, the infusion center closes at 4:00. The nurses called the doctor to ask if I could do the transfusion tomorrow morning at 8:00 instead and he said that it can’t wait. He told them that if they can’t do it today I would need to be admitted. Getting admitted would suck for two reasons – it would mean staying overnight even though I just needed a quick one hour transfusion & it would mean another $500 admission fee.

Luckily, the lab was able to rush match the blood and had the platelets to the nurses by about 3:45. One of the nurses graciously offered to stay past her shift to administer the transfusion, even though she doesn’t get paid overtime. The platelet bag finished around 4:30 and I was able to head home.

Here is the plan put in place by the new hematologist:

  1. Look at my blood smear under a microscope to see if there were any Giant Platelets the machine weeded out and didn’t count.
  2. The platelet transfusion – Check!
  3. Begin IVIG (pending insurance approval, which takes 24-48 hours). He wants to have me do IVIG four days in a row (excluding weekends). He said it takes about five hours each time and it involves being hooked up to an IV for those five hours. 
  4. See how the IVIG works. If it works, I can begin tapering off the steroids, but he will have to closely monitor my hemoglobin to see if it starts dropping. If the IVIG doesn’t work, he wants to do a bone marrow biopsy to see if my bone marrow has stopped producing platelets for some reason.

He has me out of work until after IVIG is complete. I can work from home, but he doesn’t want me commuting into the city on the train. All I would need is for one person to accidentally elbow me and I could very likely start bleeding internally. Unfortunately, there aren’t usually any visible signs of internal bleeding until it’s too late.

The Discharge

Treatment
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My hemoglobin number went up to 8.7!  It was the first time that it increased without a transfusion of any kind.  My platelet count was still low, but not dangerous, and 8.7 still isn’t very high for hemoglobin, but my body’s version of “high”/”normal” is going to be different than a healthy person’s.

The doctor cleared me for discharge around 4:00 PM.  Earlier in the day even I was switched from “SBA” to “Independent” and was able to go to the bathroom on my own and walk to the gift shop with my mom. By 1:00 they gave me my last round of steroids and then removed my IV.  Soon after they took off my portable heart monitor and let me change back into real clothes!

When I was discharged, my urine was still a little orange, but my stomachache, muscle fatigue, and jaundice were gone.  We stayed at a local Hampton Inn for the night to relax before driving back to NJ on Thursday.  I’ll know more once we see the hematologist on Tuesday!  Fingers crossed that the steroids are enough to have normalized my platelets and RBCs.  

The Diagnosis

Diagnosis
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My Tuesday morning hemoglobin count was 7.9 and my platelets were back up to 33,000.  The threshold they usually use to determine whether or not to transfuse a patient is 8.0.  Since I had only been on the three-times-a-day dose of steroids for 24 hours, they decided to wait it out and see what Wednesday’s number looked like.  They wanted to give the steroids time to kick in and do their job.  Also, there is always a risk with a transfusion, especially when the blood isn’t an exact match.  If Wednesday’s number is up then I will likely be able to go home.  If Wednesday’s number is down, despite the added steroids, I will have to start IVIG treatment, which is an infusion once a day for three days (this would make my earliest departure Saturday).

Everything came back negative.  By process of elimination, it was determined that I have Evans Syndrome.  Evans Syndrome is a drop in two of the three blood groups (in my case, red blood cells and platelets) with no underlying cause.  The primary course of treatment is steroids.  These are used to suppress the immune system and temporarily stop it from destroying healthy cells and platelets.  I will likely be on a large dose of steroids for the foreseeable future.    

I got to walk around the hospital halls with an aide on Tuesday while wearing a pulse oximeter so they could measure my heart rate and oxygen levels.  Luckily, I did so well that they took me off the oxygen mask!  As I slept Tuesday night, my heart rate dropped to 45 beats per minute and ICU sent the nurse in to wake me up and make sure I wasn’t crashing.  If anything, this just proved that my tachycardia was fading!

The Second Transfusion

Diagnosis, Treatment
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Monday morning they drew multiple vials of blood.  They, of course, wanted to check my numbers, but also wanted to start ruling out certain illnesses and determining the underlying cause of my anemia.  They checked for various things, including low iron, vitamin B12 deficiency, rheumatoid arthritis, hepatitis, lupus, and HIV.  They tried to determine if my antidepressants or birth control could be causing a problem.  

My hemoglobin was down to 5.9 overnight.  The doctor wasn’t super concerned because they had only expected it to hit 6.2 the day before, but they upped the steroids to three times a day and scheduled another two units of blood to be transfused.  My mom and dad hopped in the car and rushed back to Saratoga.  Luckily, the transfusion went well again and my numbers an hour later were at 8.9 (another three point jump)!

The hematologist had the nurses put foot compressors on my feet to keep my blood flowing and prevent clotting.  This was due in part to the fact that my platelets dropped to 27,000.  Also, I was switched from “wheelchair to bathroom” to “standby assist”, meaning someone only had to walk me to and from the bathroom and not wheel me there!  I was able to sit up without being out of breath and now we just had to wait to see what Tuesday’s numbers and test results brought!

The First Transfusion

Diagnosis, Treatment
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With a preliminary diagnosis of Hemolytic Anemia, there were still a large number of unanswered questions.  The most important thing, regardless of the cause of the anemia, was to figure out my blood type and get a match from the local blood bank so that I could receive a red blood cell (RBC) transfusion.  My cells needed a boost.  The initial lab work showed that I was A Positive, but that my blood had multiple antibodies in it, making my blood type rare.  This meant the lab had to draw another vial to be sent to the Red Cross in Rochester for further testing.  A courier literally drove to the hospital in a van to collect my sample and drive it the four hours to Rochester.

While waiting for a transfusion, the lab set out to find the cause of my hemolytic anemia.  There are three causes for low hemoglobin: stunted creation of red blood cells, premature destruction of red blood cells, and internal bleeding (excessive loss of red blood cells).  Creation of RBCs happens in the bone marrow.  If creation is low, treatment usually involves a bone marrow biopsy and eventual transplant. Thankfully, in my case, my lab work showed that my young red blood cell (retic) count was high.  My bone marrow was working overtime to try to get enough red blood cells into my bloodstream.  Unfortunately, my body was destroying these red blood cells faster than my bone marrow could produce them.

A transfusion was the only option.  I was admitted to the hospital around 4:30 PM on Saturday, May 28th and it took until the morning for a transfusion.  During that time, my symptoms grew increasingly worse.  My platelet count dropped to 33,000 and my hemoglobin dropped to 4.2.  I officially had about one-third of the amount of red blood cells that I should have.  I didn’t know it at the time, but my aunt and mother, who drove up Saturday evening and spent the night at the hospital, were very nervous about me even making it through the night.  A code went off in another patient’s room and my aunt jolted up thinking the worst.  The doctors talked about moving me to the ICU instead of the cardiac ward, but I wouldn’t have been able to have nearly as many visitors.  I was glad I didn’t know the severity of my condition at the time.  It would have made my 18-hour wait for a transfusion even more excruciating.

Saturday night was a struggle.  Anytime I had to use the bathroom, I needed a nurse to wheel me into the bathroom in a wheelchair, wait outside the door, and wheel me back to bed.  This was because of my oxygen levels and tachycardia.  Also, I only got shakier and more jaundiced through the night.  The reason my levels dropped to 4.2 by morning was because I had been given three IV bags of fluids and all of the fluid was diluting what good blood I did have left.

My blood type was rare and they didn’t have time to check out-of-state for a perfect match so they pumped two units of the “least incompatible” blood into my system.  The transfusion took about two hours per unit.  Thankfully, I didn’t have any of the side effects that can come with a transfusion, probably due to the other medications they had me taking to prevent such a reaction: folic acid, Tylenol (to reduce the risk of fever), steroids (to suppress the immune system and keep it from killing these new cells), & Benadryl (to reduce the risk of an allergic reaction).

The doctor expects that with each unit of blood that is transfused, a patient’s hemoglobin will go up one point.  An hour after the transfusion, it should have been at 6.2, but was instead at 7.2!  Hooray!  My aunt and my mother helped me freshen up, got me some food, and then drove back home Sunday night.  As long as the steroids were keeping my numbers steady in the morning, I was good to go!

Sunday night I was still being carted to the bathroom in the wheelchair, which turned out to be a good thing, since it meant the nurse knew where I was at all times.  I got up to go to the bathroom and while I was in there, my heart rate spiked to 150 and ICU (the team that was in charge of my portable heart monitor and tracking my heart rate) called the nurse in a panic.  Luckily, she knew where I was and was able to get to me and make sure I was okay.

The only reaction I was having from the steroids on Sunday was extreme hot flashes and sweating.  The nurse helped arrange ice packs around me like an igloo so I could sleep comfortably and my husband stayed with me until I fell asleep.

The Emergency Room

Diagnosis
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My husband, my mother-in-law, and I arrived at the Saratoga Hospital Emergency Room around noon on Saturday, May 28th.  The minute I mentioned chest tightening as a symptom, they whisked me back to Triage 1 and immediately hooked me up to an EKG.  I think it is the fastest I have ever been seen in the ER.

Thankfully, the EKG showed that the strain wasn’t on my heart.  They walked me back to a private room where an ER nurse took my vitals and started me on IV fluids for dehydration.  She also drew blood for the lab and asked for a urine sample.  The bathroom was literally two doors down from mine and I had to stop twice to catch my breath.  When I returned from the bathroom she checked my vitals again and informed me my oxygen saturation was low and my heart rate increased 40% when I stood up (tachycardia).  I was put on in-room oxygen while I waited for someone from radiology to wheel me in for a chest x-ray.

The x-rays showed no spots/shadows on my lungs, no clots, and no concerns.  Whew!  By the time I got back from radiology, the phlebotomist was waiting to take more blood.  The first round had hemolyzed because it was taken through the IV instead of directly from the vein.

After the phlebotomist finished, the PA told me I would be getting three CT scans (chest, abdomen, pelvis) to check for signs of internal bleeding or clotting. Two nice ladies wheeled me to the machine and informed me that, if I consented, my abdomen CT would be with contrast to better highlight blood vessels and tissues and check for tears or bleeds.  I’m happy the technician vividly and accurately described all of the strange sensations the iodine injection would make me feel, otherwise I am 100% positive I would have thought I soiled myself.  The scans showed an enlarged spleen and liver, but, thankfully, no internal bleeding!

When I returned back to my room, the results of the urine sample and blood draws were back.  The PA explained to me that my liver enzymes were slightly raised, my bilirubin count was high, and my hemoglobin and platelets were both extremely low.

Important definitions

Hemoglobin is the protein molecule in the red blood cells that carries oxygen to tissues and returns carbon dioxide from the tissues to the lungs to then be released.  An average hemoglobin count is between 12 and 18 (usually 12-16 for females).  My count was at 5.3.  My baseline blood work from six weeks prior, when I had first started the diet, showed a count of 10.7.  

Bilirubin is an orange-yellow substance made during the breakdown of red blood cells.  It passes through the liver and is eventually excreted.  A high bilirubin count can indicate an increased rate of destruction of red blood cells, which is also called hemolysis.  My raised bilirubin levels were the cause of my dark urine and jaundice.

Platelets are cells that travel around the bloodstream and bind together to repair broken blood vessels.  When your platelets are low you are at a higher risk for internal bleeding and blood loss because your body cannot form clots.  A normal platelet count is 150,000-450,000 per microliter of circulating blood.  My platelet count was 39,000.  My baseline blood work from six weeks prior showed a count of 43,000.

So what does all this mean?  My numbers were low – too low – and I was admitted with jaundice and a preliminary diagnosis of hemolytic anemia.

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