Kicking AML’s Ass: Cycle 2 – HLA-mismatch

Posted by @ 12:22 pm on Saturday 26th March, 2016.
Categories: Illness and injury

Rewind to Thursday... Day Ward as previously arranged. In for a platelet infusion. Theoretically a routine "in & then home" job...

This visit didn't follow the usual pattern. I wasn't send down to Phlebotomy to give a blood sample prior to having the infusion, and Day Ward didn't do the usual temp/pressure/sats/rate observations either. Specifically, comparing platelet counts from both before & after an infusion is the accepted way to ensure a valid value for the platelet increment, an indicator of how many platelets stay in and don't get rejected. I pointed out those omissions three times before kick-off, but nobody did anything about it. After yet another cannula insertion (right elbow), they just got on with the infusion process. The platelets were HLA-matched (from Colindale), so in theory I wouldn't need to be pre-treated as I had been before. Nevertheless I was given a shot of Piriton beforehand just in case.

It all went in well, so after the infusion had finished they took some bloods (for the "before & after" comparison which was doomed to failure because of the pre-infusion bloods omissions) and removed the cannula. Then, 30 minutes after the infusion had finished I started shaking and baking again. Spiking at 39C. With nausea and vomiting just for added excitement.

They wanted to gave me a shot of something IV and to take some bloods but the cannula was gone. They had to put another one into the right elbow, that one too was removed after use. They were treating me for phantom sepsis again, they still were not seeing the familiar pattern in their records being repeated before their eyes.

The S&Bs had abated an hour or so later but they kept me under close observation for a further few hours before telling me that I'd be admitted as a precautionary measure. I had to wait a few hours more while they found me a space on the Osborne Assessment Unit where they put in yet another cannula (left elbow) so that they could give me some IV Tazocin and an 8-hour 1l bag of saline to start at about 1 a.m..

Sometime in the early hours they put another cannula into my right elbow, I think it was to take bloods but I was too tired to pay much attention.

At about 9 a.m. when the bag had finished the saline cannulation site looked like this:

Plenty of saline under the dressing, plenty of blood under the dressing and leaking from the cannula entry and from the extension tube union. It was worse 3 hours later, I had to insist that it was all removed and cleaned up as it was putting me off my lunch. By then the extension tube had unscrewed and the cannula was open. Earlier, the other cannula (in the right elbow) was found to be dislocated and had to be pulled.

When the docs arrived during their Good Friday rounds I was told that I'd be kept in for 48 hours due to their perceived risk of sepsis and that I would need more IV treatments for sepsis during that time, and therefore at least one more cannula would be required. They weren't expecting the resounding "NO!" as I withdrew consent for further cannulation, and recommended a PICC line to replace the one that they really shouldn't have removed back on the 14th. I sent them away to review their options, and eventually they relented and started non-IV alternatives. We agreed certain conditions... oral antibiotics so long as my temp and obs were all "in the green", but anything critical and I would allow essential cannulation only if a PICC line could not be arranged.

Late on Friday they transferred me up to the now-familiar Ward 41, where the nursing staff were gob-smacked by the whole affair. I've been advised that someone will be formally reporting the bad cannula episode.

It's now Saturday and as I expected my temps and obs have all been "in the green" since the 48 hours of monitoring started. No signs of sepsis or other infection, feeling fine. Slight nosebleed (now stopped) but they don't have any platelets in stock for me so that's a good thing.

So, only 3 more days of my life wasted... so far. The are keeping me in tonight as well, so make that 4. That won't make me any happier.

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