driftinggull83 said:My mother is 67. She was discharged from the hospital about three weeks ago following a bout of pneumonia, at which time her hemoglobin was normal at 13.7. They also detected a significant heart murmur, though we haven't really addressed that yet. After about a week, she started feeling this weakness, and it just seems to be getting worse. Her blood work now shows a hemoglobin level of 4.7. She’s had four transfusions so far, and I guess she’s feeling a bit better now. She is still hospitalized, so I don't have any other lab results on hand. They aren't seeing any signs of internal bleeding.
She deals with diabetes and, until fairly recently, struggled with high blood pressure, though that has since stabilized to a normal or even low range. Over the last five years, she experienced two significant nosebleeds, which resulted in her being hospitalized. However, those episodes haven't recurred lately.
About eighteen months ago, they were dealing with the exact same symptoms, which led to the discovery of a polyp and some gastric ulcers. The polyp was removed, and the latest gastroscopy came back clear. They’re currently waiting on a colonoscopy, but since there hasn't been any intestinal bleeding, I suppose that might be a good sign. What else could this potentially be? Does anyone here have any experience with this?
How is such a rapid drop in hemoglobin even possible? A follow-up X-ray shows pneumonia in the exact same spot.
brightgull95 said:This is all just a massive assumption at this point, and we all know that an assumption is basically the mother of all screw-ups. Actually, I suppose you could even say it's the great-grandmother of all mistakes, but regardless, that's how it stands.
If that "heart murmur" (whatever its intensity on a scale of 1 to 6—or I to VI for those who prefer Roman numerals) was caused by aortic valve stenosis, and assuming there are no signs of pancytopenia (low leukocytes and platelets), then simple hemolysis resulting from highly turbulent blood flow through a severely calcified aortic valve is a plausible explanation. I suppose I have even encountered a case like that personally before. Of course, I must emphasize that this is merely a hypothesis, so none of this is necessarily correct. Pneumonia could also be a factor, though I find that somewhat less likely at this moment, especially if her mother isn't currently battling severe sepsis.
A small update, if anyone happens to have the time or inclination to offer an opinion. 🙂
After two months of peace, my hemoglobin has dropped again. I suppose she caught the symptoms earlier this time, though—she made it to the hospital with a hemoglobin level of 66.
The hematologist has taken over her case now. They performed a bone marrow biopsy, which came back normal. She was discharged today following her fourth blood transfusion, with all her results looking fine.
In the meantime, she passed a segment of thin bowel, which appeared quite orderly. The gastroscopy and colonoscopy were normal, as were all of the abdominal ultrasounds.
She had her cardiology appointment recently. Heart rhythm was regular at about 70 bpm, with clear heart sounds. There is a coarse systolic murmur over the precordium, specifically at the apex, graded at an intensity of 2-3/6. The diagnosis is obstructive hypertrophic cardiomyopathy, featuring SAM +/ with a peak gradient of approximately 115 mmHg. Her SCD risk score for HOCM is calculated at 3.03%. At this stage, I guess they aren't recommending an ICD implantation just yet.
The gynecologist found some fibroids that need to be removed.
The next step involves a small bowel video capsule endoscopy. However, since there hasn't been any visible bleeding thus far, I suspect the results might come back unremarkable. We'll hopefully gain more clarity once that's done. Who would you recommend consulting for a second opinion on this? Thanks in advance.
