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  • This autoimmune hemolytic anemia doesn't show up in regular bloodwork

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    Old 08-31-2004, 10:03 PM   #1
    Dear Maggie
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    Dear Maggie HB User
    This autoimmune hemolytic anemia doesn't show up in regular bloodwork

    The autoimmune hemolytic anemia from 2-butoxyethanol poisoning doesn't show up as you would expect. This is really a mystery. Everything can look OK in the initial tests: CBC, WBC, PTL, Hemoglobin and Hematocrit ... just a borderline normal RBC

    And even when all the red blood cells must be premature, and there is a trace of blood in the urine ... still enough of the results for all being ok

    One man wasn't even making enough red blood cells per 'retic ratio' 15 years after exposure ... yet still other tests are saying he is OK

    A mystery!

    Details here healthboards.com/boards/showthread.php?p=1170909#post1170909

    Last edited by Dear Maggie; 09-01-2004 at 05:22 AM.

     
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    Old 09-14-2004, 12:35 PM   #2
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    Re: This autoimmune hemolytic anemia doesn't show up in regular bloodwork

    My mother died from autoimmune hemolytic anemia almost 30 yrs ago. If what I'm told is right, not much was known about it then, and it went undiagnosed. She was admitted to the hospital and 4 days later she died. I understand people don't normally die from this. I was told she was given too many blood transfusions too fast and that lead to her death.

    I looked up a few websites on this, but most were so technical I could not understand them. What is it caused from? Anyone know?

     
    Old 09-14-2004, 05:44 PM   #3
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    When did your mom feel fatigue?

    Thank you for caring enough to want to know more. The chemical, 2-butoxyethanol also is known as ethylene glycol monobutyl ether and I suspect people in the early 1940's and before could have been harmed by it.

    It was invented by the chemical companies in the 1930s

    What did your mom do? Or more precisely, what was she doing the day she felt a horrible fatigue hit ... with flu-like symptoms and usually other symptoms like grouchyness & glandular problems and headaches can start up shortly thereafter. Even concern for liver and kidney function, etc.

    I did have a lady share with me that her father had something similar and that they have to warm the blood and give it slowly over an 8 hour period. Two other transfusions not done this way failed, and a 3rd time of that would have killed him.

     
    Old 09-15-2004, 11:38 AM   #4
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    Re: This autoimmune hemolytic anemia doesn't show up in regular bloodwork

    My mother was a housewife. She had a severe case of anemia when she gave birth to my oldest sister and would have died if it were not for the blood transfusions she was given then.

    She had very bad allergies and took shots for them. She often complained of headaches. She said she saw an aura before getting them and that it felt like someone was beating her over the head with a hammer.

    She had been seeing a dr for her flu like symptoms for a month or more. The day she was rushed to the hospital she was very jaundiced and if I was told right, she was vomiting blood. She was only 41 yrs old.

    I have all of her medical records. She did get better on the 2nd day of her hospitalization and told us she was coming home. I guess the effects of the blood transfusions (giving them too fast) hit her on the 3rd day. She went into cardiac arrest three times , but the last time was the end for her.

    I have always wanted to know more about this, but have never found anyone who knew anything about it. Thank you for your interest.

     
    Old 09-15-2004, 01:45 PM   #5
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    Dear Maggie HB User
    look through this info, please

    On this thread I share a lot of information with a gulf war vet as to what the symptoms are, etc.

    Please read through this

    If she had flu-like symptoms for a month + it is most likely that whatever cleaning product she was using ... or maybe she was doing a painting project or something ... was continually re-exposing her to the chemical 2-butoxyethanol.

    She had several symptoms, so check to see if there was blood showing up in her urine and if there was a 'retic' ratio taken (reticulocyte count) which will only reveal too high early on ... or too low, much later on.

    healthboards.com/boards/showthread.php?p=1170909#post1170909
    Read through pages 7-10 of this thread

    The Walter Reid Army Medical Center said that hemolytic anemia was very rare. I suggest it is as common as CFS, CFIDS, and 'gulf war syndrome' plus the many, many others that have the symptoms but not the official diagnosis.

    When someone is chemically poisoned by a chemical such as 2-butoxyethanol, some tests do not read right. In particular, there are too many immature red blood cells and many other tests are not reading OK, including the one which would indicate blood anemia.

    And one more question:
    There is usually a grouchiness with this and headaches, often, but not always or not all the time. Did your mom have any of these other symptoms before child birth?

    Were you born before or after this time?

    Last edited by Dear Maggie; 09-15-2004 at 03:59 PM.

     
    Old 09-15-2004, 02:38 PM   #6
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    Re: This autoimmune hemolytic anemia doesn't show up in regular bloodwork

    I will get her medical records out and look at them. I do know that her urine was a dark brown color, and I also read in the reports that it was thick, almost jelly like. I do not know if that was before she was admitted to the hospital or after. I'll look at the records. We were also told at the time (1975) that this was a very rare disease.

    I thought I read somewhere about steriods possibly having something to do with this. That is why I mentioned the allergy shots.

    My grandfather, her father, has always had a problem with low platletts and I wonder if this has anything to do with her?

    By the way, I read the posts on the Gulf War syndrome. My husband is also a GW vet and is suffering from symptoms.

    And I appreciate the time you're taking to explain or help me to understand this. I have had so many unanswered questions throughout the years about this.

    Last edited by offdahook4now; 09-15-2004 at 04:19 PM.

     
    Old 09-15-2004, 04:07 PM   #7
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    Blood draws are said to be thick and dark

    When did her urine start showing up dark like this? For it to be thick like jelly at the time of admission to the hospital, it means that there was an immense amount of red blood cells being prematurely destroyed by her immune system, poor dear. Whatever was the exposure for her, she had no idea what it was ... nor did the medical profession, most likely ... or so that has been the case as to this chemical's exposure, that is for sure!

    Many times at time of blood draws, the lab tech will notice that these have blood that is thicker and darker than normal. (Dark because there isn't enough oxygen in the blood... not enough mature red blood cells)

    Many people can go back to the very day of their exposure to 2-butoxyethanol based on a combination of flu-like symptoms, fatigue, dark urine and eyes watering and burning?

    Just wondering ... were you born before or after your mother's fatigue?

    I would also note any urinalysis that your mom had. They may not have checked some stuff on red blood cells like 'retic' ratio ... but hopefully they did. Maybe you can help shed some light on this, too

    I suspect your husband to be harmed by the same chemical. What does his urinalysis say?

    Last edited by Dear Maggie; 09-15-2004 at 04:17 PM.

     
    Old 09-15-2004, 04:11 PM   #8
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    Re: This autoimmune hemolytic anemia doesn't show up in regular bloodwork

    Here is some of her medical records. This is just a small bit of it. To answer your question, I was born in 1965. My mom was born in 1934 and died 1975. She was tired alot due to her anemia.

    I apologize for the lenght of this but maybe you can tell me what it means.

    Thanks!!

    This lady presented to the ER with a hemoglobin of apx. 5. A diagnosis of Coombs. positive, autoimmune hemolytic anemia was made. The patiend was started on Prednisone 100 mgs daily with an extremely poor response. Apparetnly the hemoglobin got down to apx 3. At this point, it wasfelt that blookd transfusions were nec. despite the hazards involved. The patient was transfused. Today she was transferred to ICU and further transfustions were carried out. The patient developed respitory arrest, cardaic arrest associated with massive hematuria. Diagnostic considerations at this time remained that of hemolytic crisis, microangiopathic hemolysis, massive transfusion reaction. Combination of massive hemoglbinuiri and hypotension pre-disposed to acute tubular insufficiensy which seems well established at hte present time in that the patient is oliguric. She also remains in shock. EKG reveal sinus tachycardia. There is diffused bleeding from the GI tract, vagina, urinary tract and there are multiple superficial puncture sites.

    There are alot of tests, but I don't know what they mean or how to read them. I'll list some of them and maybe you can make sense of them.

    6/ 12/ 75
    Hematology

    TEST
    WBC x 10 5 2 .6
    4 7 .4 Corrected wbc

    RCB 1.09
    HGB 3.4
    HCE 1 1.0
    MVC 1 0 1
    MCH 3 1.0

    Myelocte 1
    Metamyelocyte 1
    Band 15
    PMN 68
    Moncyte 3
    NUCL RBC (11) ( something else I can't read)

    anisocytosis 3+

    Polchromasia 4 +

    Reticulocytes 43.0

    evaluated for folic acid

    results:

    4.3 NG/??
    4-16 NG/ml ?

    Next day:
    Reticulocytes 34.0

    HBG 4.0
    HCT 12.0

    next day:

    HBG 3.7
    HCT 13.0

    More tests: I believe urine

    Color: Amber
    Character: Cloudy
    Reaction: 6.5
    Pecific gravity 011
    Alb??? 3+
    Sugar neg
    Hemoglobin Large
    WBC/HPP ( or HFF) 10-12
    RBC/HPP ( of HFF) unreadable
    Crystals ( 8-10 course granulear c??)
    Casts/LPF 60-70 ceblular cast???


    Looks like they also gave her bone marrow.


    This 41 yr old female presented to the ER complaining of headaches. Originally the pain was occipital in nature radiating to the frontal region, it became subsequently generalized at the time of admission. The pt tried bed rest for 3 days before she came to the ER. PT said that she was aking darvocat 10 #4 and Empirin with only mild relief and also there was nausea and vomiting the day before admission. The patient had a long history of migraine headaches. The pt also gave a history or anemia since the age of 12. She had several courses of b complex and b12. She also has numerous allergies. She gave a history of having some transfusions when she was going through childbirth. The pt was also taking antihistamines and allergyg shots.



    The physical exam at the time of admission revealed the temp to be 97.4, pulse of 120/minute, resp. rate 24/minute, bp 144/78. The pt appeared markedly anemic, slighly obese, and severely jaundiced. The conjuctivae were pale. The sclerae were icteric. The fundi did not reveal any evidence of hemmorage, exudate, or papilledema. The neck was supple, no thyroid enlargement. There was no palpable lymphadenopathy in the cervical, axillary, or inguinal region. The thorax was essentially normal. Lungs were clear. The heart showed no evidence of ardiomegaly. There was ????? moderate tachycardia of 124/minute. The blood vessels showed the pulses were palapable in all superficial blood vessels. There was no evidence of hepatosplenomegaly. Genitourinary did not reveal any evidence of tenderness in the cardiophranic angle. Musculoskeletal did not reveal any abnormality. Extremities showed no varicosities, pitting edema or ulceration. Neurological exam was normal.

    Initial workup in the ER revealed a white blood count of 23,700, red blood count was 1,550,000, hemoglobin of 5.7 gm, hematocrit of 15.9 % slightly microcytic indices, RETICULOCYTES of 17.6%, many sperocyes, jaundiced plasma. The differential showed 2 myelocytes, 1 metamyelocytes, 7 bands, 76 PMN's, 9 lymphocytes, 3 monocytes, 2 eosinophils, and 2 nucleated red blood cells. The CPK was normal. The electrolytes were within normal limits. Direct Coombs was 2+. URNINALYSIS SHOWED A SMALL AMOUNT OF HEMOGLOBIN. The total bilirubin was 7.7, direct bilirubin was 1.0. The creatinine was 0.8, SGOT of 38, LDH of 1207. Diagnosis of Coombs positive hemolytic anemia was established.



    There is much more, but maybe this is enough to figure it out?

     
    Old 09-15-2004, 04:33 PM   #9
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    I think we need some help here

    Quote:
    URNINALYSIS SHOWED A SMALL AMOUNT OF HEMOGLOBIN
    This is blood in urine, right?
    I did notice that the Red Blood Cell count was very low.

    Quote:
    Normal generic range of Red Blood cells for female: 4.2 to 5.4 million cells/mcl

    Because men have more muscle, the regular normal range for them are
    male: 4.7 to 6.1 million cells/mcl
    notice they talk about 2 nucleated red blood cells in one of the samples, those are immature red blood cells?

    I notice that they were checking the reticulocyte count.

    Quote:
    Reticulocyte Count Definition: A test that measures the percentage of reticulocytes (slightly immature red blood cells) in blood.

    A special stain can be used to identify reticulocytes, because they contain remnants of RNA. Fully mature red blood cells are terminally-differentiated cells lacking nuclei and nucleic acids. The number of reticulocytes in the blood is proportional to their rate of synthesis and release by the bone marrow. The body will respond to bleeding or hemolytic anemia (breakdown of red blood cells) by an increased rate of red blood cell synthesis under normal circumstances.
    I noticed on one person's hematology report that the 'retic' was normal at 0.5%-2% So is 34 a count or is that the percentage?

    I only studied this chemical. . . and people known and suspected to be harmed by it. I'm not a medical person.

    Last edited by Dear Maggie; 09-15-2004 at 04:36 PM.

     
    Old 09-15-2004, 04:47 PM   #10
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    Re: This autoimmune hemolytic anemia doesn't show up in regular bloodwork

    I believe it is percent. I found another reference to reticulocytes saying they were 31.0 % on another date.

    I wish I knew more about this, but sorry, I don't. I don't know if my mom was exposed to any chemicals because I was too young at the time to know, or even remember. Even if she was, I bet no one connected the two.

    I'm going to read some more of these reports. Some are harder to read than others.

    Thank you once again.

    Last edited by offdahook4now; 09-15-2004 at 04:48 PM.

     
    Old 09-16-2004, 03:33 AM   #11
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    Re: This autoimmune hemolytic anemia doesn't show up in regular bloodwork

    I found a very good site that explains reticulocytes. Sometimes they are expressed in percentages and/or whole numbers.

    [url]www.med-ed.virginia.***/courses/path/innes/nh/normbasics2.cfm[/url]

     
    Old 09-16-2004, 09:51 AM   #12
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    Re: This autoimmune hemolytic anemia doesn't show up in regular bloodwork

    We always knew my mom was ill most of the time. Besides that, she had 5 children of her own, and 4 step-children she took care of. I went through her complete medical history, from the time she was pregnant in 57 with my sister until she died.

    She went to the dr. alot and some of her major complaints were : chest pains, shoulder pain, pain in the legs, shortness of breath, confusion, fatigue, congestion due to hayfever and allergies. She also mentioned tightness in chest and most of all headaches.
    These symptoms occured 3 yrs before she died. How long before she died would she have been exposed to this chemical? I'm trying real hard to think about her activities, but am coming up blank.

    Is it possible that she passed something on to me? Here is the thread I started in the GWS telling of my symptoms, and my husbands.

    oops... forgot to add the url
    [url]http://www.healthboards.com/boards/showthread.php?t=207800[/url]


    I can totally relate to the symtoms you mention, except I have no suicidal tendencies. I don't know about MS, but my half sister has this. Different mother, same father.

    Short term memory loss
    Difficulty concentrating
    Personality changes to 'grumpy' - Extreme Irritability
    All the time Depression
    Suicidal Tendencies
    Difficulty sleeping
    Some get MS


    I think I'm getting more confused the more I read. :-(

    Last edited by offdahook4now; 09-16-2004 at 09:53 AM.

     
    Old 09-16-2004, 10:51 AM   #13
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    Re: some autopsy findings

    Autopsy report mentions spleen marekly enlarged weighing 425 grams. Says:
    The aplenic capsule apprears smooth and pale pink-purple. On cut section the cut surface appears deep red and the spleen is soft and mushy, this represents acute congestive splennomegaly.

    I noticed on all these copies I have, someone put X marks in the marigins to indicate interest. Spleen was one of them, Bone marrow is another and kidneys:

    Bone Marrow: Sections of bone marrow showed a marked degree of erythroid hyperplasia. Very little fat is present in the marrow. Numbers of megakeryocytes are normal. The cells of the erythrocytic series are diffusely and markedly increased.

    KIDNEYS:
    The renal tubules stain poorly, apparently a combination of autolysis and perhaps necrotic changes as well. There is also a suggestion of sloughing of renal tubular apithelium. The glomeruli stain poorly and appear to be autolyzed. Thrombi within glomeruler capillaries cannot be recognized. Small hemorrages can be seen in the peripelvic adipose tissues. One section of kidney shows what apparently represents extensive necrosis of the renal cortex. In the areas of extensive necrosis groups of colonies of organisms can be seen here and there.

    Last edited by offdahook4now; 09-16-2004 at 11:07 AM.

     
    Old 09-16-2004, 11:22 AM   #14
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    Re: some autopsy findings

    Quote:
    Originally Posted by offdahook4now
    Autopsy report mentions spleen marekly enlarged weighing 425 grams. Says:
    The aplenic capsule apprears smooth and pale pink-purple. On cut section the cut surface appears deep red and the spleen is soft and mushy, this represents acute congestive splennomegaly.

    I noticed on all these copies I have, someone put X marks in the marigins to indicate interest. Spleen was one of them, Bone marrow is another and kidneys:

    Bone Marrow: Sections of bone marrow showed a marked degree of erythroid hyperplasia. Very little fat is present in the marrow. Numbers of megakeryocytes are normal. The cells of the erythrocytic series are diffusely and markedly increased.

    KIDNEYS:
    The renal tubules stain poorly, apparently a combination of autolysis and perhaps necrotic changes as well. There is also a suggestion of sloughing of renal tubular apithelium. The glomeruli stain poorly and appear to be autolyzed. Thrombi within glomeruler capillaries cannot be recognized. Small hemorrages can be seen in the peripelvic adipose tissues. One section of kidney shows what apparently represents extensive necrosis of the renal cortex. In the areas of extensive necrosis groups of colonies of organisms can be seen here and there.
    All of this is very valuable information and important for people to take note of. Many times the harm of 2-butoxyethanol's secondary symptoms are all that are noted ... such as the native man I just shared on. He had to have the same autoimmune hemolytic anemia underlying these problems, but did his doctor's find it? Maybe there will be something in his early blood work or urinalysis that will say?

    You are doing VERY, VERY well to make so much sense out of what I'm sharing and the medical information on your mother. The spleen being enlarged, as you will note, is also one of the signs of hemolytic anemia.

    People need to look at the BIG PICTURE and in this day and age of so many specialists, something may be getting lost. A gulf war vet just shared that he paid $182 to get CBCs with differentials and a urinalysis and was not given a copy of the medical results even after asking the lab for a copy. I think he also said that the doctor was no longer available ... moved orsomething ... and the lab said that there were new rules and they were prevented from giving him a copy of his own lab tests. How very sad. This must not be the case; and if it is, we must lobby our Congress to change it!

    Now, one more question, Did your mother exhibit any fatigue or related symptoms PRIOR to getting a blood transfusion? I do wonder whether people with Chronic Fatigue could donate blood, and then the altered immune dysfunction is passed along to someone through a blood transfusion. This is a scarry thought. But I have wondered about it.

    As to you, I'll read your other post for symptoms, but do you know when they started? It is possible to inherit ailments from a parent who is damaged ...as this chemical is a teratogen: it harms the developing fetus.

    However, second hand exposure is very real; and so is being exposed directly to this chemical. It is in so many things! I would estimate that there is a lot less hereditary harm ... that diseases run in families as doctors suppose ... and that it is more damage from chemicals either directly, from a parent, or by getting vapors into one's eyes from a spouse or other close association.

    One parent of a bioremediation worker of the Exxon Valdez oil spill cleanup found out that her son had 3 friends he shared a college dorm room with. And knowing the potential harm of this chemical from second hand exposure (those rooms are pretty small) and the strong exposure her son had, she is starting to contact the parents of the other 3 boys. If they were affected, they would have NO IDEA what had harmed them. That they were second-handedly exposed to 2-butoxyethanol.

     
    Old 09-16-2004, 11:44 AM   #15
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    Re: This autoimmune hemolytic anemia doesn't show up in regular bloodwork

    Now, one more question, Did your mother exhibit any fatigue or related symptoms PRIOR to getting a blood transfusion? I do wonder whether people with Chronic Fatigue could donate blood, and then the altered immune dysfunction is passed along to someone through a blood transfusion. This is a scarry thought. But I have wondered about it.

    Records say she had anemia since she was 12 yr old. That would cause fatigue. She had the 1st blood transfusion when she was apx 23 yrs old during childbirth. I don't know anything about this time period.

    I do know that when I was a kid as far back as I can remember, she was always fatigued. (raising 9 kids could make anyone fatigued though.) Always had bad headaches, and bad allergies.

    I never saw my mother in the hospital before she died. ( after her blood transfusions) My brother and I were too young to be admitted into ICU to see her. I have all of the blood transfusion records, and it looks like there were alot of units of blood ( 10 or more)she rec'd. I dont' know how many transfusions.

    I was mistaken about how many days she was in the hospital. She was actually in for 6 days. I was also wrong on the number of cardiac arrests. She had 4 and the 4th one was the last.

    I'm going to ask my sister if she can remember my mom being exposed to any chemicals.

    One more thing: my husband used to be a frequent blood donor. If I remember correctly, after the gulf war, they would not accept his blood.

    Last edited by offdahook4now; 09-16-2004 at 12:20 PM.

     
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