Does anyone know how serious very low hemoglobin is for a woman (90)?

It could mean that she has internal bleeding. What did the ER docs say?

This is a very serious situation. This could be an internal bleeding problem, but there are many many other things it could be...bone marrow disease, cirrhosis, leukemia, other cancers, etc. etc. I am also interested in what the ER found.

How low? And how changed from her last reading, and when was that?

One difficulty is that obvious treatments such as transfusion are also not risk-free for very frail patients. Depending on the cause and the ER's findings there could be some difficult decisions ahead - but I hope it turns out to be a salvageable situation, and please let us know how it goes.

ER will do bloodwork, and check for blood in urine and stool. They will check 02 levels and may add oxygen. They might even do some imaging studies to look for the leak. At 90, it could just be a gradual shutting down of the bone marrow. Not much fix for that. Transfusion buys time , but it is not a permanent fix.

Thank you to all for your responses. They want her to complete all transfusions . before they continue with tests. However, she has a history of gastritis/peptic ulcer. On top of this, she has dementia and is being difficult. Today she actually pulled out the transfusion IV ! I will be back tomorrow as we should know more.

I want add (my apolologies - long day) MD wants to avoid doing an endoscopy due to her age, frailty. She needed 5 units of blood.

Oh my. Has anyone mentioned hospice? It might be tome for palliative (comfort) care, as ipposed to trying to cure this.

To give an update: MIL had endoscopy done this morning; results - negative for any bleeding. MD would like to do colonoscopy but not until Monday- to give her a break and us time to think about it.

Two things to think about for Monday:

1. What is MD looking for?
2. What does he plan to do about it if he finds it?

Unless there are clear answers to those questions, leading to likely, demonstrable benefit, putting a frail lady with dementia through a colonoscopy is not ideal. Don't be afraid to say enough.

Utzie50, I am sending prayers that you find useful answers. Keep the faith.

Ask what the treatment will be if they find "something" during the colonoscopy? Are you willing to do that treatment?

Is she going to survice the prep for the colonoscooy?

What will happen if they do nothing? Is that an unacceptable outcome?

Good thoughts and prayers. But ask questions so that if it's time to stop treatment and keep her comfortable, you know it.

Countrymouse: Thank you. That is exactly what I asked my husband as I had to go to work today & did not see the doc myself. DH did not pursue this. SIL will speak to MD by phone 2moro. pamstegman: thank you -I will keep the faith. I hoped to get to hospital 2 moro myself, but we are expecting "snowmeggedon" here! When it "snows", it pours.

Utzie, if it turns out she's not making enough RBC's, then they can give her a medication to help stimulate the marrow to make more. It could work if that is what your choose. Is her B12 and other nutrients okay? (I know it's too late to check now, since she received blood. Maybe they ran a panel first?)

Don't be (openly!) annoyed with DH: I'm sure he'd rather just not think about it, let alone discuss it. When we had a similar dilemma, I canvassed views from all close family members (didn't help - twelve people, fourteen opinions), and the one best qualified to give a clinically informed reply came back with "oh, poor Granny!"

Hope you get some sensible answers via SIL, and that meanwhile MIL is more comfortable now that she has a measurable red cell count :) Thanks for updating.

This sounds like over utilization of procedures. She needs palliative are rather than being poked and prodded and with dementia it's even more stressful on her
Give her love and her family around her with comfort

I thought about this seriously. I wouldn't know which way was best, since she is in the NH with dementia. It would depend on how much she enjoyed her life now. These are some tough decisions.

Yes they are tough decisions but a family meeting might be helpful with listing pros and cons of her desire for treatment/ wishes. Dementia is increased by lack of oxygen to the brain and that can be caused by low hemoglobin. Something to take into account .... Hope all works out

My first thought was about the prep. She's had a few in the past but in her present condition, I can't imagine she'll hold it down or even swallow it.

pamstegman: and .. thanks for the prayers.

I appreciate everyone's thoughtfulness and knowledge. Hopefully, we will know more tomorrow.

Utzie, thinking about you and your family today.

the transfusion were probably lifesaving in themselves at the time. I assume there is not a DNR in place. Do you really want these interventions in someone this age with dementia. I would not. Is there any evidence that she is bleeding from anywhere? Are they sure she has not done something like fracture a hip? It would not necessarily be obvious and you can loose a great deal of blood into the tissues when that happens. To me this is screaming Palliative/Hospice care. maybe she fell and ruptured her spleen. There are so many unknowns here and in the elderly the perception of pain is likely to change. Take your time.

I agree about asking what the colonoscopy is for. Is she strong enough for surgery, if the results say that is called for? If not, then what is the purpose. I have read that the American Cancer Society does not recommend cancer screenings for people who have a terminal illness like dementia.

When my great aunt became ill, she was in her late 80's and not strong enough to undergo surgery or chemo. (She had had radiation treatments the previous year on her face for cancer.) Her doctor believed cancer had returned somewhere else in her body, but did not recommend a colonoscopy, since she was so weak and would not be strong enough to have the cancer treated. She agreed.

God bless you, your mom, and family during this difficult time, Utzie.
And a blizzard-snowmaggeden on top of all that.
Just, be safe as possible.

The colonoscopy is on for tomorrow of MIL. SIL agrees with MD that it's necessary in order to see if the colon is where the blood loss is occurring. If there's a polyp (she has a history of benign polyps) or cancer causing bleed. My husband agrees. I don't know if they tested her stool. I think we all agree that chemo, surgery is out. There is a DNR in place.

Thanks for the update. Will they be able to remove the polyp during the colonoscopy, or will there have to be a second procedure? I understand that you are not sriving this bus, but with a person of that age who is frail I worry about the electrolyte imbalance/ that might be caused by the prep.

I am just throwing up my hands in horror here. Why find out if the bleeding is coming from the colon if everyone agrees that M/L is too frail for surgery/chemo.
If that much blood has been lost and it is coming from the colon it would be pouring out of her rear end! What do they plan on doing stuffing her up with Tampax. This borders on elder abuse. They plan on force feeding her a gallon of noxious fluid tonight, letting her suffer the inevitable diarrhea and then in the morning subjecting her to the actual colonoscopy which hopefully won't be too uncomfortable. However given her age and condition they will most likely be pretty sparing with the sedation because of the risks involved.
The POA and the rest of the family need to be lined up and given a gallon of the prep,then made to stand in line for ONE toilet.
I can't write anymore I am so incensed.

PS This is another case of "I studied medicine on line and you can too" Real diplomas from out credited college $350 each.

Not even to speak about the fragility of the lining of the intestines! One last chance at the big bucks for a procedure!!! I agree with Veronica.

Maybe you should delay at the very least-get a second opinion. If the patient is too frail for surgery-she is too frail for colonoscpy-makes sense?

Who does a procedure on someone with low hemoglobin? Whats with that?