Dear Dr. Roach: My mother, who is now 81, has very low iron. She has to have iron infusions. The infusions last from six to eight weeks. Afterward, the iron level is fine for a little while, and then she has to go back again. They have done several tests, including a colonoscopy and a bone marrow biopsy, but they don鈥檛 know why she is losing blood or where it is going. This has been going on for way too long. She also has said that her siblings have to take iron supplements, but she is the only one losing blood and having transfusions.
V.C.D.
I have seen people hospitalized with this condition because the blood loss is so much of a problem. It sounds like your mother鈥檚 blood loss isn鈥檛 quite that rapid, but here are some lessons I鈥檝e learned from taking care of many people like your mother.
By far the most common place to lose blood is in the GI tract, but it can happen anywhere from the mouth to the anus.
The colon is the first place to look, and sometimes the source of blood loss can be missed on the first colonoscopy, especially if the preparation wasn鈥檛 perfect. I don鈥檛 think they would have missed a cancer or a large polyp, but small abnormal connections between arteries and veins, called AV malformations, can bleed. They might be a source of blood loss.
Because the blood contains iron, the blood has to leave the body in order for iron levels to go down. A second colonoscopy may be necessary.
However, other parts of the GI tract can be affected, especially the stomach, the small bowel and the liver and biliary tract. A bleeding scan, done with radioactively tagged red blood cells, can find small amounts of bleeding, but the bleeding has to be active at the time of the scan. I鈥檝e seen a few cases of nosebleeds causing this problem, when the blood went backward, down the esophagus, rather than out the nostrils. Blood loss from the bladder is a rare cause.
Sometimes the problem is absorption. Several conditions can keep the body from absorbing iron, the most common of which is celiac disease. Given the family history, that might be worth testing for.
Dear Dr. Roach: Could you tell me the difference between idiopathic pulmonary fibrosis and COPD?
D.L.
Idiopathic pulmonary fibrosis is a rare, but increasingly prevalent, disease of the lungs of unknown cause.
It is thought to be related to abnormal repair after lung injury. It happens in people over 50 and is more common in men. The major symptoms are cough and shortness of breath, especially upon exertion. The diagnosis can be suspected after a CT scan, but a lung biopsy may be necessary for certainty.
Chronic obstructive pulmonary disease is a very common condition. While the strongest association is with cigarette smoking, it can happen in people exposed to other lung irritants, such as cooking fires (especially outside the U.S. and Canada) and occupational exposures, and in people with a deficiency of the enzyme alpha-1 antitrypsin.
Cough and shortness of breath are the most distinguishable symptoms of COPD. The diagnosis is made based on a patient鈥檚 history and X-ray or CT scan results.
This is just the tip of the iceberg: I recommend The American Lung Association's information, found at https://tinyurl.com/jyu27vt and https://tinyurl.com/hl494ww for those interested in learning more.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
