Where will I go for my follow-up appointments?
- Your follow-up appointments for your lung transplantation will be at the Transplant Center at Desk A-110.
- The first month after you are discharged from the hospital, you will have a follow-up visit once a week.
- The second month after discharge, you will have a follow-up visit every other week. After that time, your lung transplantation coordinator will discuss your follow-up schedule with you.
- Your follow-up visits will be frequent at first, but will gradually taper off as your condition improves following lung transplantation.
What happens during my follow-up appointments at the Transplant Center?
At your follow-up visits, you will be seen by the lung transplantation coordinator and your physician. You will receive a thorough physical examination and have blood tests at each lung transplantation follow-up appointment. Many times, these are the only ways rejection or infection can be detected.
Generally, your Transplant Center follow-up visits for your lung transplantation will be set up in the following format:
7:30 - 8:15 a.m.
- Do not eat anything for 12 hours before your appointment.
- Do not take any of your medications or eat before your blood work appointment.
- Arrive at The Cleveland Clinic.
- Go to Desk A-15 (located on the first floor of the Crile or A Building) and report to the lab.
- Eat breakfast and take your medications after your blood work appointment.
- Go to Desk A-21 for a chest X-ray.
8:15 a.m. - Noon
- Check-in at the Pulmonary Medicine Desk (Desk A-90) located on the 9th floor of the Crile Building.
- Check-in at the Transplant Center Desk (Desk A-110) located on the 11th floor of the Crile Building.
- A nurse will weigh you, take your vital signs and review your medication list.
- You will meet with the pharmacist, who will discuss your medications and answer any questions you may have about them.
- You will meet with your transplant coordinator.
- You will meet with your physician. He or she will discuss your present condition, review current lab work and make any necessary changes in your medications.
Routine blood tests
In order for the Transplant Team to effectively monitor your lung function and evaluate your treatment, it is important that you have frequent blood tests. The blood work must be completed by 8:00 a.m.
Routine blood work includes the following tests, which are done in a laboratory:
- Electrolytes—evaluates levels of:
- Sodium (Na)
- Potassium (K)
- Carbon Dioxide (CO2)
- Blood Urea Nitrogen (BUN)
- Creatinine (CR)
- Magnesium (Mg)
- Complete Blood Count (CBC)—evaluates the following:
- White Blood Count (WBC)
- Hemoglobin (HGB)
- Hematocrit (HCT)
- Platelets (PLT)
- Cyclosporine (CYA)—analyzes your cyclosporine (Neoral) level
- Tacrolimus (FK506)—analyzes your tacrolimus (Prograf) level
After the initial three months following transplant surgery, the frequency of your lab work will be determined at each clinic visit. If your lung function is stable, your lab work may become less frequent, but it will always be necessary.
Where can I have the lab work completed?
Your lab work may be completed at Cleveland Clinic or any outpatient lab center that is convenient for you.
If you decide to complete your lab work at an outpatient lab center, you can take a written order for routine blood work (provided in this booklet) to that center each time, or the orders can be faxed or called in. After analyzing the electrolytes and complete blood count, the lab center should report the results to the Cleveland Clinic Transplant Center.
It is important to remember to take a shipping box or “mailer” to the outpatient lab center each time your blood work is completed. A tube of blood will be mailed by your lab to The Cleveland Clinic, where the results will be reviewed by the Transplant Team. This tube of blood analyzes your cyclosporine (Neoral) or tacrolimus (Prograf) level. It is important that the levels of these medications are analyzed at the same laboratory, because not all laboratories use the same method of analysis.
If the tests indicate that your dose must be changed, your transplant coordinator will contact you.
What do my blood work and tests tell the Transplant Team?
The following information will help you understand the meaning of your blood work and tests:
Complete Blood Count (CBC)
The Complete Blood Count (CBC) is a series of tests that are usually done all at once by an electronic counter.
The CBC provides information on the components in the blood, including:
- Red blood cells (erythrocytes)—These are disk-shaped cells that contain hemoglobin and give blood its color. Red blood cells make up about 40 percent of the volume of blood. Hemoglobin is an iron-containing protein that carries oxygen from the lungs to tissues throughout the body, and carries waste products (mainly carbon dioxide) back to the lungs to be exhaled.
- White blood cells (leukocytes)—These cells are part of the immune system and play an important role in fighting infection in your body. White blood cells are colorless and have a granular appearance, with a flexible membrane.
- Platelets—The smallest blood cells produced by bone marrow, platelets help the blood to clot when blood vessels become injured. Platelets create a mesh at the wound site, called a fibrin strand, to trap red blood cells and form a clot.
White Blood Cell Count (WBC)
A rise in the number of white blood cells may indicate a bacterial infection in your body. In contrast, a very low white blood cell count may indicate a viral infection.
The white blood count is checked routinely to effectively guard against infection. Normal white blood count levels range from 4,000 to 10,000.
Hemoglobin is the iron-containing pigment of the red blood cells. The main function of hemoglobin is to carry oxygen from the lungs to tissues in your body. Normal hemoglobin levels range from 12.0 to 16.0 for women, and 13.5 to 17.5 for men.
Platelet Count (PLT)
Platelets are cells that play an important role in the clotting of blood. Some transplant medications may cause the number of platelets to decrease, making you more susceptible to bruising. Low levels of platelets may cause a cut to bleed longer—a symptom you may notice after having your blood drawn. The normal platelet count ranges from 150,000 to 400,000.
Refilling your prescriptions
Because your local pharmacy might not routinely stock transplant medications, these companies can fill prescriptions by mail:
- Cleveland Clinic Pharmacy: 800.223.2273, ext. 42100
- Amber Pharmacy: 888.370.1724
- CVS Procare Pharmacy (formerly Statlanders): 800.598.2136
When you call, ask for the new patient department and tell them you are a transplant recipient. They will need this information:
- Your name, address and Social Security number
- Date of your transplant and facility that performed your transplant
- Your transplant coordinator’s name
- Name and telephone number of your insurance company
- Insurance group number
- Your employer’s name and telephone number to verify insurance (if applicable)
After your transplant surgery, your transplant coordinator and social worker will work with you to make sure you are able to fill your prescriptions.
Guidelines for your bronchoscopy appointment
- Do not eat or drink anything for 12 hours before the scheduled appointment.
- The morning of the scheduled appointment, take ONLY your anti-rejection medications with small sips of water, including: Prograf, Neoral, Imuran and Prednisone. Do not take any other medications before your scheduled appointment.
- If you take Coumadin or any other anticoagulant (blood thinning) medications, stop taking it five days before your scheduled bronchoscopy appointment. Restart your normal dosage of this medication 24 hours after the procedure.
- Arrive 15 minutes prior to your scheduled appointment. Report to the Lab at Desk A-15 for your appointment.
General health care guidelines after transplant
- Take your blood pressure and record it once a day. (Take it twice a day if you are on blood
pressure medication or if your blood pressure is above normal.)
- Take your temperature and record it once a day.
- Weigh yourself and record your weight every day.
- Perform your spirometry exercises once a day and record the results.
- Maintain your routine blood work schedule as recommended by your transplant coordinator.
- Have a liver function test every six months.
- Have a complete physical examination at least once a year, including a complete health risk assessment (which includes a review of your exercise, nutrition, stress management and other health risk factors).
- Have a urinalysis and urine culture at least once a year.
- Have your blood cholesterol checked once a year.
- Have a digital rectal exam every year after age 40.
- Have your stool checked for blood every year after age 50.
- Have a proctosigmoidoscopy exam (a visual exam of the lower third of the colon) after age 50. If the results of this test are negative two years in a row, this test can be performed less frequently (every 3 to 5 years), as determined by your health care provider.
- Follow the immunization recommendations of your health care provider. These may include vaccinations for chickenpox (varicella), diphtheria , tetanus, pertussis, TB, hepatitis B, typhoid, pneumovax, rabies, immune globulins, influenza.
Recommendations for Females
- Perform a breast-self exam once a month.
- Have a breast exam once a year by your gynecologic health care provider.
- Have a pelvic exam and PAP test once a year.
- Have a mammogram once a year after age 40, or earlier if recommended by your health care provider.
Recommendations For Males
- Perform a testicular self-exam monthly.
- Have a digital rectal exam every year after age 40, along with a blood test that detects PSA. (Prostate Specific Antigen)
For More Information
If you have any questions or concerns, please call us at 216.444.6996. We will be happy to answer your questions.