written on September 26, 2014
Today was my first plasmapheresis session. I had to be at Cedars at 9 am to lie down in a bed while they plugged me into a centrifuge machine that pulled the blood from my body (via my catheter – this is why I kept the catheter this long and didn’t switch to peritoneal dialysis (the one you do at home)) and pushed it through the centrifuge that separates the red blood cells from the plasma. The machine removes the plasma and adds albumin to my red blood cells and returns the new mix back to my body. Even though I called it plasmapheresis, it’s really a plasma exchange, because they’re completely removing my plasma and not changing it.
Of course I was a bit anxious. I’m used to having my blood removed from my body and then returned to me (that still sounds so weird to say or write – and yet this is how I’ve been living). I had the big fear of the unknown going on this morning as I drove to Cedars – will it hurt? Will I feel anything? How will my body react?
The doctors and nurses I’ve been talking to kept reassuring me that I wouldn’t feel any different, that the most common side effect is fatigue. And really, being tired after having my blood removed is pretty par for the course. It’s currently one of the main side effects from both dialysis and the medications I’m on, so being a little more tired than normal is no big thing.
But my mind had gotten the better of me before I got there – my blood pressure at the start was 147/100, which is the highest the diastolic has been in a few weeks. By the time I finished, it was back to normal – 134/87. And in dialysis it’s been as low as 124/79, so I’m doing okay.
I have three more plasma exchanges scheduled for next week (Monday, Wednesday, Friday) and a possible fourth one scheduled for next Thursday (Oct 2), in case my blood work comes back a little too high on Wednesday.
They’re doing these exchanges to remove blood-type A antibodies from my system. Since my wife is a blood-incompatible donor (she’s type A and I’m type B), Cedars is prepping my immune system to not reject her kidney outright. Last week I had my 6-hour IV infusion with a drug called Rituxan. Rituxan is supposed to prevent my body from making more A-antibodies, and the plasma exchanges are removing the A-antibodies I already have (turns out the antibodies in our system live in blood plasma – who knew?). Hopefully I won’t ever have to have another Rituxan treatment, but I might if I go through a rejection episode in the future.
So Wednesday they check my blood titer, which lets them know how many A-antibodies are present. My current level is 32, but they want it as low as 8, or even lower. If my blood work on Wednesday shows an 8 or lower, then I won’t have to do another plasma exchange next Thursday.
And next Friday, after the plasma exchange in the morning, I have to dialyze at Cedars so they can give me another infusion of something called IVIG. IVIG is not a drug – it’s an infusion of IGg antibodies – I think they’re giving it to me to prevent certain types of infection, since I’m guessing the plasma exchanges are removing all of my antibodies and this puts some back in me. Either way, I’ve been told I’m probably not going to be feeling all that great after that one, so someone will have to drive me home.
And next weekend we have to clean the house and get ready for my wife’s parents to come and help out with the kids. I’ll move into the apartment on Sunday Oct 5 and I do pre-op blood work on Monday the 6th. Then Tuesday the 7th is the big day. Hard to believe it’s right around the corner. Makes me wonder where the summer went. Oh yeah, it went to suffering migraines from dialysis – how could I forget?
I expect the migraines will be gone for good soon. That’s the goal and the plan anyway – after October 7, I’m expecting to go back to “normal.” Although it will be a “new normal” again, but it should be dialysis-free, and that’s worth the price of admission.