Low Hemoglobin, High Blood Pressure

[Restorer]

I just got my November labs back. My hemoglobin was at 7.9, lower than it's been all year. I've been getting EPO shots every two weeks, 20,000 units. What can cause dropping hemoglobin like this? I was at 11 just a few months ago. I'm supposed to make an appointment with my neph on Monday to get it checked out, and to look at my high blood pressure. For the last several weeks, my BP has been high, on the order of 144/100. Sometimes it causes me terrible headaches that Tylenol does nothing for. I've been on Toprol XL 25mg (a beta-blocker) since the early part of the year.

I'm thinking the high blood pressure might be because I'm absorbing PD fluid - I'm on CAPD, and I haven't had any of the tests yet that show how fast I transport or the like, but I almost always drain off less fluid than I put in (though I'm still urinating quite a lot). When I first got on PD, I gain fluid weight and my feet and legs swelled way up, my weight was up about 7 pounds from dry weight. Recently, my weight has been up 3-5 pounds from dry, but I haven't been swelling at all. I'm afraid the fluid is staying in my circulatory system and causing the high BP. Make sense?

I guess I'll be talking with my neph about all this soon, but I kinda have to get through finals first.

[nursewratchet]

You didn't mention your Iron levels.  Without adequate Iron stores, you cannot make red blood cells, despite the EPO.  You could be taking ALOT more EPO if you only get it every 2 weeks.  Also, any infection, or inflammatory process (Lupus, Arthritis,etc) will lower your HGB.  Any recent wounds, bleeding, etc. 

[wrandym]

  Also, any infection, or inflammatory process (Lupus, Arthritis,etc) will lower your HGB.  Any recent wounds, bleeding, etc. 

Would this include gout?  My blood count is low and I am suffering through a case of gout at the moment...

[paris]

Your iron stores may be the problem.  I get iron infusions when my levels are low. They sustain the red blood cells; the Epo shots are helping to produce the cells.  With sufficiant iron, your red count will to down.   Hope you find an answer soon.  I know you must be feeling crummy at below 8 and on top of that to have gout.  It is really painful.   Let us know what you find out.   

[Restorer]

My November labs didn't include iron. My quarterly labs next week will probably include that.

I just found my lab sheet from September, and at that time my PD nurse didn't point out anything wrong with my iron (I can't recall, maybe she explicitly said it was okay).

   Iron                       68    mcg/dL
   UIBC                       157   mcg/dL
   TIBC                       225   mcg/dL
   Transferrin Saturation     30    %
   Transferrin                155   mg/dL

This was immediately before starting PD. Earlier in the year, I received two IV iron infusions because my iron was low at the beginning of the year. I used to be taking 20,000 units of EPO once a week, then my hemoglobin reached 11 and they dropped me to once every two weeks. When I visit my neph, he'll probably have me do some blood draws, if it's before my December labs.

And I don't have gout. 

[nursewratchet]

If that is Sept. lab, it is too old to be helpful.  At Sept. data, your Iron looks good.  Dec. will tell the tale.  Good Luck, and keep posted.  Gout is considered an inflammatory process, for who ever was asking. 

[Restorer]

Had December labs drawn today, will see my nephrologist on Thursday afternoon. Then we should see what's going on with me.

[Restorer]

I saw my nephrologist on Thursday afternoon, and we discussed things. He had seen my December labs, but didn't have them handy (I haven't seen them yet), and he didn't recall anything that looked too wrong. I asked specifically about my hemoglobin, and he said it looked like it was going up - but I'm never especially convinced when he tells me these sorts of things. He asked about my energy levels, which have been moderately low lately, so he prescribed benazepril to replace my metoprolol, which can cause tiredness. The benazepril is the lowest dose (10 mg), but can be increased up to 40 mg as needed.

On Friday I got a call from my PD nurse that my nephrologist also wanted me to increase my Renvela to 3 pills with each meal.

We'll see if any of this helps my numbers.

[nursewratchet]

Why would he see you in office, without having your labs handy?  And what does "looks like your Hemoglobin is going up" mean?  That's very poor physician follow up. 

[monrein]

I always need to see my own labs as soon as they are received by anyone.  It's the only way ,I feel, for me to become well-acquainted with the values and their implications and I often formulate my own questions for my neph based on my labs, my research and discussions with nurses at the centre.  We really should all be taking back this control.  Heaven knows we've lost enough of that.