Maia's Into The Moonlight

HEMOLYTIC ANEMIA

"Doing My Own Thing", oil on canvas, 90X100 cm

In December of 2006 I was in Brazil, but did not feel like dancing the samba. I was staying across the street from Ipanema beach in Rio de Janeiro, and I did not want to plunge into the waves. I did not even feel like walking along the beach. I was happy just sitting and drinking my favorite drink in the world, coconut water. If not sitting on the beach, I would sit with a book in the hotel room.

Such behavior was highly unusual for me. Normally I enjoy the beach at the earliest hour, without the crowds and the strong sun. Walking, running, swimming. Or else walking in the old part of Rio looking at its wonderful, crumbling, colonial architecture. There I was in Brazil with music bursting from every corner, every open door or window, where walking is difficult because your body just wants to sway to the contagious rhythms, and yet I did not dance.

Something was very wrong.

When we returned to Spain I spoke with Dr. Hamblin. Upon learning how low my hemoglobin was – 8, when it should be 12-16 – we flew to Bournemouth the next day and Dr. Hamblin took blood for a Coombs test to see whether I was suffering from autoimmune hemolytic anemia. The lab results confirmed his diagnosis.

Hemolytic anemia happens when a defective immune system attacks perfectly good red blood cells. The red blood cells, which are crucial oxygen carriers, are killed off faster than they can be replaced by the bone marrow. So the result is anemia, low hemoglobin levels and low hematocrit. If left untreated, autoimmune hemolytic anemia is life threatening.

After discussing possible treatments, Dr. Hamblin recommended I begin treatment immediately with Chlorambucil, Prednisolone and Allopurinol. Clorambucil, until recently, has been the first-line chemotherapy for CLL, and it is considered to be the mildest. The Prednisolone was to treat the hemolytic anemia, and the Allopurinol was to counter-act some of the side effects of the Prednisolone.

I was to take Prednisolone until my hemoglobin rose. Both Prednisolone and Allopurinol are important to the cure, but both have nasty side effects, both immediate and over a longer term.

Some weeks into the treatment I developed a terrible allergy to Allopurinol so it had to be suspended. This was followed by neutropenia, which means not enough neutrophils to fight infections. At one point I was rushed to the hospital with very high fever that kept getting higher. In a separate episode, I had what is called fevers of unknown origin. I also had to have a blood transfusion. I was lucky if during all the time the treatment took place I could sleep more than 3 hours a night. That part was fine with me though, as being insomniac, I enjoy those secret hours of the night when the whole world is asleep and I feel I am the only person awake.

Considering the grave threat posed by hemolytic anemia, the treatment was not too bad. After 5 months Dr. Hamblin had me discontinue medication. I did not get complete remission, but I got cured from the hemolytic anemia, my spleen decreased somewhat in size, and my leukocyte count even normalized. Throughout these months I bombarded Dr. Hamblin with questions and doubts. He was always wonderfully patient, explaining everything over and over and dispelling my fears and doubts. Dr. Hamblin again saved my life.

And I started dancing the samba again.

To be continued.