Dear All,

As you all know, mom is in Lourdes Medical Center presenting with a profound iron deficiency anemia, fully compensated with no shortness of breath (SOB), stable vital signs (pulse 84, bp 124/80), guaiac negative stool. Chemistries were: Hct 25, Hb 6.5, MVC 61, SeFe <10, TIBC 579, %Sat 1%, Ferritin <5, INR 1.8-2.0. Admittedly, there is some disparity between the Hct & Hb, but after 3 units of packed red blood cells (3 unit transfusion) her H&H yesterday morning was only 26.7/8.8 so then Stan Hales & I decided to transfuse her an additional 2 units for a total of 5! Her H&H post transfusions and equilibration is a healthy, respectable 37.0/11.3.
We then also decided to get her double endoscoped as it had been 2001 since her last colonoscopy, but only 6-8 weeks from her recent EGD-upper endoscopy. Stan & I spoke with Dr Maher and he was most willing to come in on his Saturday off, not on call, for her. He attended to her from ~6pm-10pm. Mom was double endoscoped last PM by Dr Donald Maher. We finished @ 10:00pm. Her upper endoscopy was unremarkable except for her large hiatal hernia, but no mucosal breaks, etc. Her colonoscopy and terminal ileoscopy was normal but for a bit of left sided diverticulosis.
The summation is that she likely has small bowel telangiectasias (AVMs=arterio-venous malformations, microvasculature bleeds) which ooze blood from time to time, especially while she's on her Coumadin. I need to review again with Dr Markle the indication for her coumadin anticoagulation. I believe there is a concern re a history of Pulmonary Embolism (PE) and atrial fibrillation(AF). In any event, she is good, will be discharged this morning and will need iron supplimentation for a few months to get her iron stores replenished.
Thank God for good doctors like Dr Hales, Dr Maher and Dr Markle and mother LeeAnn!

Pray for her in Mass today!
Mike