Blood for the Win?

Maybe? 

Hopefully?

Not sure yet, but it's early.

Not quite as early as they woke me, though.

Last night was rough. We switched ventilators, and didn't see much improvement. We added iNO (inhaled Nitric Oxide) and didn't see much improvement. Plus he would have desats that were pretty significant. 

He currently has two pulse ox probes on, one on his hand and one on his foot. When we widened his PDA last summer, that made it so he had more of a pop-off valve when his pressures were high, but it also means that his upper extremities have a higher oxygen saturation than his lower extremities. The difference between the two tells us how bad his pulmonary hypertension is, or if might be his lungs (asthma, pneumonia, a cold) that's causing issues instead. 

Well, last night his pre-ductal probe was dropping into the 70's, and his post-ductal into the low 50's. Over and over again. For reference, when he's well, we only do post-ductal and he's usually in the mid to high 80's. I mean, can you see keeping a pulse ox probe on this kid's hand? Yeah, me neither. 

We did finally get him to settle down with the plan that if it continued, they'd draw another CBC and see where his hemoglobin and hematocrit was. It was okay but not fabulous when we were admitted, and cardio kids, especially PH kids, tend to do better with higher crits and hemoglobins. 

Apparently that happened because at 4:30 am, the resident woke me wanting consent for a transfusion. He wasn't dangerously low like in February 2022, but it was low enough and we were also out of other options. 

So yeah, he got some good red stuff, and now he's looking better. He is sad for some reason, and this kid almost never cries. But his oxygen both pre- and post-ductal are much, much better. They're better enough that we're going to try to start weaning him down from 100% FiO2. He needs to get to about 50% before we start weaning his iNO. Once that's off, we can try his home vent. 

It's a process, but I'm hoping it will be (relatively) straightforward.

Now the question will be, why is he needing blood every few months?? 

Is he becoming a vampire?

"We are linked by blood, and blood is memory without language." 

~ Joyce Carol Oates