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Anemia after surgery

rae_rae's picture
rae_rae
Posts: 264
Joined: Oct 2010

It's been over four months (Oct 8) since my radical nephrectomy of my left kidney and though I went back to work full time after seven weeks off, I don't have the energy I used to. I get winded very easily, fatigue is more common than before, my fingernails and toenails are splitting and breaking and I was told at my first check up last month that I am anemic (evidently I was last year as well but this is the first time the doctor mentioned it). I feel like I am in a mental fog half the time. Other than that I feel great.

Has anyone else had problems with anemia after surgery? I know most of my symptoms can be due to anemia though I am not severely anemic so I do wonder about my symptoms. I mentioned this to my doc at my check up last month and he said Hmm...my lung xrays were fine so...he had nothing else really to say.

Anyone else suffering from anemia after surgery? And no, I didn't have problems with anemia until some point last year after I was diagnosed with kidney cancer.

Thanks,
Rae

ams123
Posts: 71
Joined: Aug 2011

Hi Rae,

I just found your post from 8 months ago when I was googling anemia after surgery. What was the outcome of your situation? I am 4 weeks post-op, and I lost blood during the surgery and had a blood transfusion two days later. But I am still having symptoms of what I think is low hemoglobin. I made an appointment with my pcp for first thing Monday morning, and I assume she will send me to the lab for a blood draw.

How are you doing now in regards to the anemia?

Linda

Rayman NY
Posts: 12
Joined: Jul 2011

Hi Linda

I like you, am 4 weeks post surgery yesterday. I been making a point to go and drive every morning just to get out of the house and start building some stamina. I notice that when I was out that I would get lightheaded and a little dizzy. I would be very tired when I got back home. Now part of that could be from not sleeping at night. I made an appointment yesterday with my Primary Care Doc. My blood pressure which was on the high side dropped to 120/75. I was looking very pale. My doc immediate diagnosed me with post surgical anemia. My last blood work at the hospital was on Sept 19th the day before discharge. My hemoglobin was at 11. The low end of good for men is 13. I was at 15 before surgery. So, doc put me on iron pills, multi vitamins and I stopped and bought raisins and spinach (Yuk)... I saw my surgeon a week a go and he did blood work but he did not ck for this. My surgeon mention to me that I was very pale and again my blood pressure was low for me but he didn’t address that issue.

So when I came home yesterday I started to Google post surgical anemia and saw your post on this subject. I just hope I am not bleeding internally somewhere... I will have to re-do blood work in 14 days. I scheduled to go back to work in 16 days.

Since we both share the same surgery day. How are u doing ??

Rayman

ams123
Posts: 71
Joined: Aug 2011

Hi Rayman - I've been back to work for 2 weeks, but not working as many hours as I did before the surgery. I also get lightheaded and dizzy when I go from a sitting or lying position to standing, and I am also very tired in the afternoons. My cardiologist told me to take my blood pressure every day and it has been around 115/60, which isn't low. Before my blood transfusion in the hospital my hemoglobin was 8, in June, which was the last time it was tested before the surgery, it was 11.9. I eat a lot of spinach and kale! I eat a plant based diet, so no meat, eggs, cheese, etc. No one has mentioned that I am pale, everyone tells me I am looking good. Maybe they are just being polite.

Other than this issue, I am doing very well. No pain at all, no more nausea, the incisions are healed, but can still get a little irritated from my shirt rubbing on them. Still wearing yoga pants, haven't attempted jeans yet! I might just wear yoga pants forever, they are so comfortable.

Thanks for telling me about your anemia situation, I'm thinking this is a common result of the surgery. I see the doctor first thing Monday morning, so I'll know more then.

Linda

KatfromFlorida's picture
KatfromFlorida
Posts: 66
Joined: Aug 2011

Hi Rae:

I don't know anything about anemia after surgery but due to some new insurance requirements I had to get a copy of my most recent blood work to post on my company website. Well, after visiting my doctor today and getting a copy of those results I had to google what I found, my RBC- Red blood cell count was high, as was my hermatacrit and hemoglobin and it appears there is a condition called Polycythemia? Symptoms are Weakness,
fatigue,headache,itching, bruising, joint pain,dizziness and stomach problems.
The causes are listed but what I found interesting in this is that the main cause is due to a overproduction of a hormone call EPO or Erythropoietin. This is a hormone that is secreted by the kidneys normally and can be secreted in excess when a person has a kidney tumor or tumors.
Going to the doctor for me was due to some of the above issues as well as some post surgery depression and this excessive exhaustion I am going through right now.... Ironically I didn't find any iron levels listed on my most recent test but my doctor told me basically that I am still not completely healed from the surgery which is his conclusion for my exhaustion. No mention of the above test results were discussed. I go back in a couple weeks and I am going to ask if this can cause what I am going through and see what I can do to try to overcome this maybe? I dunno.
Has your doctor advised on how to correct your anemia? I have always had a problem with taking iron supplements, they do not agree with my system at all. Prayers your way and let me know what you find out?

Hugs
Kat

rae_rae's picture
rae_rae
Posts: 264
Joined: Oct 2010

Here it is the eve of my one year anniversary since my surgery and I can truly say it really does take a year to recover.
I struggled with anemia and fatigue issues for months. I also had a B12 deficiency which can go hand in hand with the anemia.

I took iron, which I hate, for a couple months but also started B12 injections which I still get monthly. I also had two blood transfusions. I was told that the red blood cells from transfused blood die off faster as well. To be truthful, September was my turning point to start feeling better.
Partly due to being prescribed topamax, which is mainly used for seizures, but also for migraines, which I suffer. It is supposed to help calm down an over stimulated brain for lack of better words. I not only have not had a migraine but have been sleeping well every night since.

Since surgery, as fatigued as I was, my body had a constant "need" to move all night. I was exhausted and restless. Now I sleep because of the tiopamax.

But I am no longer anemic- it took about six months. I will remain on b12 injections for at least one year.

Rae

ams123
Posts: 71
Joined: Aug 2011

It is interesting about your B12 deficiency because I was intending to ask my doctor to check me for that since I don't eat any animal products, and that is the only way to get B12 other than a supplement. I also hate taking iron (constipation), but maybe that is what I need.

Did you have your blood transfusions after you had gotten out of the hospital? I had one unit in the hospital and I dread the thought of having more of that. I have read that people feel almost immediately better after a blood transfusion, but I don't know if that is true. I have also heard that it takes a long time for the body to replenish its supply of red blood cells, and it has only been 4 weeks for me.

I have also been having headaches. Last week I had a 3 day migraine, and I haven't had a migraine since June. I also have been having regular headaches now and then. I've never been prescribed topamax because my migraines aren't frequent enough. I would love to take something that will help me sleep better though.

Thank you for the information, and I am glad you are doing better. I suppose I need to be more patient!

Linda

rae_rae's picture
rae_rae
Posts: 264
Joined: Oct 2010

I had the transfusions the a few hours after my surgery. My BP crashed to 72/52 and they tried to elevate it with a unit of blood, then the second unit, then finally also by lowering my epidural dosage.

I did lose a lot of blood due to a nicked spleen, which is a bloody organ, and a cut pancreas among other complications. I don't know why I am b12 deficient. Sometimes I wonder if something as simple as anemia just gets missed.

Rae

ams123
Posts: 71
Joined: Aug 2011

I see my doctor on Monday morning, and I will ask about how to correct anemia. I'll let you know. On your test results your red blood cell count is referred to as hemoglobin and hematocrit. See if those are on there.

Linda

Rayman NY
Posts: 12
Joined: Jul 2011

Linda

After seeing my primary Doc on Fri and being dignosed with anemia this was really bothering me. So,on Sat I called my surgeon and told him about my condition. He said he wants to do blood work on monday to see how low my numbers are. I told him that I started to take iron pills but he said that will take months to improve my red blood cell counts. The concern is that there might be a slow blood leak somewhere in my system. There are other things they can try like iron shots and as a last resort blood transfusion.

Good luck at the Doc's office tomorrow.

Rayman

ams123
Posts: 71
Joined: Aug 2011

It never occurred to me that there could be a slow blood leak, that is scary. Hopefully I just have a low red blood cell count due to the surgery. I am going to the doctor tomorrow, I'll let you know what she says.

Linda

ams123
Posts: 71
Joined: Aug 2011

It turns out that I do have a b12 deficiency. Hemoglobin is fine. My doctor also tested me for mono because I had a blood transfusion, and the results of that test are inconclusive. I have to have b12 injections monthly for 3 months, and then I will be retested. If my b12 has improved significantly I can switch to the oral version, but if not I will need to continue the injections.

I am relieved that the doctor discovered this, because many people were telling me just to wait, it takes time, etc. But I knew there was something else going on, we know our bodies best, and if I have one bit of advice it is to go to your doctor and ask for tests if you are not feeling like you think you should.

Linda

rae_rae's picture
rae_rae
Posts: 264
Joined: Oct 2010

I am glad you found out and did not wait. My doc just sent a letter today about b12 injection shortages- I can no longer get them and must take it orally. I hope it helps you soon!

Rae

garym's picture
garym
Posts: 1651
Joined: Nov 2009

Just moving this back to the front page

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

Gary, thanks for retrieving this info. (all before my time here). The medics don't seem to have been quick in clearing up the issues! The thread seems to have raised more questions than it's answered.

Presumably there may be some malabsorption problems that had not been picked up - e.g. coeliac disease. However, it occurs to me that one very simple explanation is quite plausible in these circumstances. NSAIDs are used by some for pain, migraines etc. and it's well established that continual/heavy use of drugs like ibuprofen and aspirin can cause bleeding in the gut that leads to anaemia. I was a little disturbed when ripper said (I forget where exactly) that he was glad to get off (other) pain meds and on to ibuprofen.

T.

rae_rae's picture
rae_rae
Posts: 264
Joined: Oct 2010

I still have no answer for the anemia or b12 deficiency but you may have a point with mal-absorption. I have read that b12 needs stomach acid to be absorbed into your system. As people age, they produce less, but also, antacids and meds like Prilosec can also cause b12 deficiency. Just a thought. And of course now they are linking ibuprofen and kidney cancer. I used to eat ibuprofen like candy for my headaches. And then took Prilosec because the ibuprofen ate up my stomach.

garym's picture
garym
Posts: 1651
Joined: Nov 2009

Personally I've never been a ibuprofen or nsaids user as they didn't seem to yield results for me and neither does acetaminophen. Fortunately I have not needed much medication for pain over the years other than for injuries or surgery etc. I do the daily aspirin routine for heart health and have taken Prevacid for many years due to acid reflux, but that's about it.

MikeK703's picture
MikeK703
Posts: 235
Joined: Sep 2010

I hadn't heard about a connection between ibuprofin and kidney cancer but anybody who has only one kidney and is taking ibuprofin or any NSAID is gambling. This is the first thing my nephrologist and urologist pointed out as something I should avoid. They have been connected to renal failure, even in moderate amounts. Even aspirin has been connected to kidney disease. The only thing left for us seems to be Tylenol (acetaminophen) and that can damage the liver. See here for more info:
http://kidney.niddk.nih.gov/kudiseases/pubs/analgesicnephropathy/

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

I believe I've found most of the answers on this one. An article in the British Journal of Urology just 3 months ago is entitled: "Comparison of rates and risk factors for development of anaemia and erythropoiesis-stimulating agent utilization after radical or partial nephrectomy".

I guess we shouldn't reproach ourselves for not knowing the things it tells us because this is the first ever investigation of the topic! The salient points, on my reading of it, are as follows.

First, to explain the title of the paper, I should mention that ESA (erythropoiesis-stimulating agent) is a synthetic version of a natural protein known as erythropoietin protein that is produced by the kidneys when they (for members of our Lone Kidney Club make that 'it'!) detect too low a level of oxygen in the blood. (The kidneys then initiate the process of producing more red blood cells to boost the circulation of oxygen.)

The use of ESA is due to the fact that anaemia is evidently one of the well-established sequelae following nephrectomy (something most/all of us didn't know - I certainly didn't). The purpose of this paper was excellently summarised in the Abstract:

"The consequences and significance of iatrogenically-induced CKD are poorly understood. Most data regarding risk of CKD and its complications are inferred from the medical literature. This is the first study to examine impact of surgical management of renal masses on development of anaemia. Patients who underwent radical nephrectomy had a significantly higher incidence of anaemia and ESA utilization than a contemporary well-matched cohort that underwent partial nephrectomy. The results obtained add to the growing body of data supporting the use of partial nephrectomy in the management of clinically appropriate renal masses."

The motivation for the enquiry is stated clearly: "anaemia is a significant cause of morbidity in chronic kidney disease."

They went about it by way of a retrospective study of 905 patients, average age 57, in two institutions over a 20 year period and they used multivariate analysis "to determine the risk factors for developing anaemia after surgery."

The key findings were that the prevalence of anaemia was worse in patients who had had radical nephrectomy than those who had had a partial and that other contributory factors to anaemia are: being over 60, smoking, being Afro-American, having a poor glomerular filtration rate (meaning that your kidneys - for most of US, this means your kidney, singular - are inefficient in the speed at which they filter fluids) and also proteinuria and metabolic acidosis.

All of this obviously bears on the topic of radical v partial nephrectomy, about which I've just added a note in the Kidney mass - RCC? thread. In this study it's noted that the tumour sizes (mean) were 7.0cm. for rad. and 3.7cm. for partial.

The one thing that is missing here, for me, is an explanation of the actual mechanism by which anaemia occurs following nephrectomy. If anyone has any info. on that I'd love to have it.

T.

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