Thanks, I hope it won't require another surgery. The plan is to go in through a vein to deploy the plug.
I was told the threshold for transfusion was hematocrit of 25% or below. (I was as low as 28% where normal for adult male is 38% - 50%). 25% means one has about half the RBCs a normal person would have. That's pretty bad and the fact that they withhold transfusions until someone is that bad, I think, shows what a shortage there is in the blood supply.
I'm on folic acid too. I had to ask for Aranesp. In fact, I went to the emergency room to get it but was told I didn't qualify because my HGB wasn't low enough (basically, go home and get sicker). When my hematologist opened an appointment slot due to a cancellation (I would still be waiting for an appointment otherwise), she said, no, the threshold for Aranesp is HGB <= 10.0, and immediately prescribed it for me. I got the first shot (200 mcg starter dose) that same morning. It's a regular injection every two weeks but I got them to advance me to one every week. My third and fourth shots were bumped up to 300 mcg. It has improved my HGB to over 11 and that's the cutoff, I think determined by insurance company's willingness to pay, since they consider 11 good enough. To be fair, I read that the original trial was done on patients with chronic kidney disease and when they tried to continue Aranesp on patients with HGB at 11 and higher, patients suffered from adverse events (clots) so they stopped trying to improve any further and just recommend its use for HGB at 11.0 or below. Now those of us on warfarin are at reduced risk of clots but that is not part of the calculus, evidently.
If I were you I would ask my physician about Aranesp, generic name: darbepoetin alfa. It's a synthetic erythropoietin (EPO), the natural hormone produced by the kidneys when they sense low oxygen (hypoxia) in its cells. The hormone stimulates the bone marrow to produce more red blood cells, which of course carry the hemoglobin which carries the oxygen our bodies need. Actually the bone marrow manufactures reticulocytes, which are immature red blood cells that take a while (1-2 days) to mature. The doctor will order reticulocyte count (normal 0.7% - 2.8%) because a high count in an anemic patient is a sign that the system is working properly and the bone marrow is producing its expected high output of new cells trying to make up for the anemia. Mine went as high as 6.9% after the Aranesp injection from as low as 1.2%. It's also possible to measure EPO directly. It's only been done once with me at 33.1 (normal: 2.6 - 18 mU/ml) prior to any Aranesp; so it was already elevated naturally by the kidney sensing low O2. My hematologist said that she has seen patients with EPO measured as high as 1800 when I asked her, if Aranesp was going to overly tax the bone marrow RBC production capacity. So there is abundant margin between 33 mU/ml and 1800 mU/ml for Aranesp to work. BTW, wikipedia says EPO can get as high as 10,000 mU/ml! That's some high-octane blood!
Good luck.
