Low blood count after Kidney Transplant

Hi @parojulie and welcome to Mayo Clinic Connect. I'm tagging a few fellow kidney transplant members to share their experiences with you, like @rosemarya @stephanierp @jolinda @rrrowbal @gingerw @ca426 @lindajo @mollyv and others.

It sounds like you had some bleeding complications specific to you. Can you explain more what you mean about being opened up two times to wash the blood? If the blood loss was explained as a side effect of internal bleeding while in the hospital, then I, too, would want to understand what is going on now that you're at home. I encourage you to call your transplant team to let them know what is going on. Do you know what was the cause of your anemia pre-transplant?

@colleenyoung thanks for responding
The anemia was explained as side effect of CKD that I was suffering during pre transplant. It was usually managed via iron infusions initially and later through Aranesp shots once a month. Due the poor kidney condition ( GFR below 10) kidneys failed to produce a hormone called erythropoietin (EPO). EPO prompts the bone marrow to make red blood cells.

Post Transplant ( 4th day) the 1st episode of internal bleeding was found via CT scan. I was operated to wash the blood out and look for any injured blood vessel. Two days after there was yet another bleeding episode found via second scan and excruciating pain I was experiencing. I was operated again to wash out blood. All these repeated surgeries made me lose blood which was compensated via blood transfusions.
I was under observation in the hospital after the second washout surgery for a week so the kidney function improved and blood count stabilized. Even though the kidney function was normalized , the HB count was unstable. It would stay at 10 or 9 a day after transfusion but drop to 7 later. There were follow up CT scan done with no evidence of Hematoma developing as before.
So I was released home after 2 units of blood transfusions the day I came home. All was well 4 -5 weeks with hemoglobin rising to 12 and then gradually dropping by week.
This week it dropped to 7.3 so was Transfused again yesterday. Its been 7weeks post Transplant so I doubt I am bleeding internally. There was a repeat CT 10 days ago which was mostly normal.

I am wondering if this drop in Hb level is normal post transplant due to the immuno drugs we are on. I have already seen drop in Platelet count due to Tacro.

I am following up with my Transplant coordinator
to see if all this is normal

@parojulie, I have a liver and kidney transplant. My kidney failure was sudden and it as caused by my liver failure. This happened 11 years ago, so please excuse me if my memory of details is vague.

When I was in early stages of liver disease diagnosis, I took prednisone for a while, and then my GI added Azathioprine so he could reduce the prednisone. I don't recall the dosage or the length of time, however I do remember blood tests every 1-2 weeks, and at my 1st lab after beginning the Azathioprine, I bled heavily at the needle site and noticed that any bump or slight skin abrasion would bleed and bruise in a not-normal way. My GI had me stop the Azathioprine immediately. Currently Azathioprine remains on my list of 'do not administer' drugs.
I think I was mildly anemic with my liver failure, and for sure, with my kidney failure. While on dialysis, I received iron infusions and I remember a couple of times I was given a blood transfusion.
After my liver and kidney transplant, at my 4 month check-up, the kidney transplant doctor prescribed an iron supplements because I was anemic. I think I took the iron supplements for a couple of years. Today, I am advised to take a plain, no iron, daily vitamin.

I definitely urge you to keep in contact with your transplant team. You are still at the point where medicines will be adjusted as your body responds. Is your transplant team involved in your current care? Some of my favorite question(s) for my team: Why is this happening? What can be done about it? How worried should I be? And of course, the questions that you posted here are essential for you to ask them.

Hugs.

Yes I am in close contact with mu transplant Coordinator and the Transplant Nephrology and Surgeon team are also watching my numbers and labs.
Labs are drawn once a week.

I did ask the coordinator is why is this happening now and she said not to panic as it does happen with critical surgeries. Then later she said the Nephrology may refer me to Hematologist. This actually caused me to panic. Hence reaching to this group to see if others who had Transplants and are on immuno drugs also experience such anemia post transplant. I do not want to be transfused every now and then and need to know what drugs can help.

Also Azathioprine is stopped for me since WBC counts fell along with platelets. I am told to resume once they get to a specific count. These drugs have so many side effects.

@parojulie And an important thing that all of us bear in mind is the fact that we are each different! While we share our journeys, we are unique, and what happens/works for one may be different for the next person. You are getting some great advice and support here. My husband received a transfusion while still in the hospital, but hasn't since then.
Ginger

@parojulie, How are you doing? Has your nephrologist made the referral to a hemotologist? Are you finding any answers yet?

Hi Rosemary!

After blood transfusion on 7/10, the Hb count this week was a bit better at 9.3 Tomorrow I have appointment with Transplant Neph and would discuss more. If the level falls next week again, would ask the Neph on the next step.
WBC count is improving after stopping Azathioprine. Platelets count are improving slowly.
Renal and Electrolyte numbers are stable.

@parojulie, How are you doing since your blood transfusion? Are your numbers improving or holding steady?