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 Low Red Blood Cell Count 
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Joined: Sun Oct 04, 2009 10:18 am
Posts: 276
Location: Washington State
Post Low Red Blood Cell Count
I received a call from my LO's primary care provider yesterday telling me that my Mom's red blood cell count has been dropping recently. The PCP thinks she is bleeding somewhere, probably in the upper GI tract since there is no blood in urine or stool and she had a negative colonscopy in '05. She wanted to confirm with me that the family wants comfort care only and palliative drug care. I confirmed that this was the case and that we would not want transfusions or intrusive testing. If the red blood cells continue to drop, it sounds like it might be an easy way to die which is what my LO has been searching for. We have an appointment on Monday with the PCP.

I do wonder whether the drop in red blood cells could be one of the many symptoms of LBD in which case it will probably change. Has anyone dealt with this as a symptom?

For reference, my LO is on a baby aspirin, desmopressin, thyroid medication, exelon (1.5 mg for 3 days now), sertraline, calcium, vitamin B12.


Sat Feb 27, 2010 10:59 am
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
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Annie - there could be lots of things that would cause the blood count to be off. I think you just need to hang in there till Mon. and see what the dr. says. I know it's hard to wait. I hope you get some sleep this weekend. Lynn


Sat Feb 27, 2010 8:45 pm
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
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AnnieN,

Have you checked all the side effects of the meds to see if this could be the cause?

I have never heard of this being a symptom of LBD.

Robin


Sat Feb 27, 2010 9:48 pm
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Joined: Sat Mar 28, 2009 6:01 pm
Posts: 101
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Annie,

My mother in her late 90's developed anemia. She did not have LBD, but was somewhat senile. When the doctor had her stay overnight in the hospital for a transfusion, she became very agitated. She couldn't understand that the blood was coming in and thought they were taking all her blood out. I had to stay with her all night, and even with sedation and strapping her down, it was a nightmare. So her doctor and I agreed that we would not do this again. Given her age, we also agreed not to explore what was behind the loss of the red blood cells. She didn't die right away, but began to weaken slowly, and when the end came, it was peaceful. She died in her sleep.

If my mother had accepted the transfusion calmly, I would have approved continuing.You have to do what is right for you and your mother.

Doris

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Sun Feb 28, 2010 2:53 am
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
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There are at least three causes of lower RBC count:
1. Lower production
2. Destruction
3. Blood loss

Even upper GI bleeding can be seen in occult blood in the stool. As Robin has suggested, some medications can cause destruction of red blood cells. Some disease processes depress the production of RBCs. I don't know the age of your mother but anemia is quite common in elderly women.

You might want to ask yourself whether it's worth testing for something that, knowing the results, would not lead to an intervention. And would any intervention lead to a higher quality of life or would it prolong suffering?

Annie, I'll be thinking of you and praying for you, too. These things are so hard!!!! :(


Sun Feb 28, 2010 10:24 am
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Joined: Sun Oct 04, 2009 10:18 am
Posts: 276
Location: Washington State
Post Had our appointment today
The result is that we don't know why the hemoglobin count is dropping. It is at 9.9 with a normal range of 12.0-16.0. It doesn't look like medications have caused this and the PCP said that they typically recommend transfusions at 8.0. What is clear is that at 87 years old my LO doesn't want transfusions. In fact she has, "no desire to do anything about anything." She wants nothing to prolong her life (including iron supplements) and wants to be dead. At this point I want to add that she is on an antidepressant and that these statements are consistent with her wishes for years now.

So, no tests to find out where the problem is. No lab work unless my LO wants it. If this continues there will be shortness of breath, weakness, and perhaps dizziness. Eventually she will sleep a lot and die. No idea when this will occur but it sounds easier on her than going through the fourth and final stage of LBD. Had a long talk with my siblings and although we didn't agree with everything, we also didn't scream at each other. Conference calls are occasionally useful.


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Mon Mar 01, 2010 11:01 pm
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Joined: Sat Jan 03, 2009 2:59 pm
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I just heard today on a TV ad that Exelon could cause GI bleeds and thats the first I heard that, as in my husbands last yr he had 3 major GI bleeds and the Exelon was never brought to my attention at the time, I did look it up and sure enough it says could cause GI bleeds, could your LO be taking Exelon?

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Irene Selak


Mon Mar 01, 2010 11:16 pm
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Joined: Sun Oct 04, 2009 10:18 am
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Location: Washington State
Post Exelon and GI Bleeds
Irene, my LO has been taking 1.5 mg of Exelon at breakfast for five days. She has no pain in her abdominal area. I'm sorry to get personal, but when you LO had GI bleeds what were the symptoms? Did he have tests done? Did you decide that the Exelon was worth it? I checked RX list and it says there is a possiblity of GI bleeds if the patient is taking NSAIDs, but that's not the case with my LO. On the other hand, she is extremely sensitive to drugs.


Tue Mar 02, 2010 12:03 am
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
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AnnieN,
I'm glad your LO is so clear as to her wishes. That makes things much clearer for everyone. Have you considered hospice?
Robin


Tue Mar 02, 2010 2:41 am
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Joined: Sun Oct 04, 2009 10:18 am
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Location: Washington State
Post Hospice has evaluated her
About a month ago my LO's Dr. recommended hospice for her. The hospice nurse came in and evaluated her and told us that LBD, and dementia in general, was not enough to qualify her for hospice. She said that my LO would have to be confined to her bed by illness to qualify. Then she walked with my LO doing her pacing with her walker through the halls and turned us down. My LO is still good at "show time" and she is very mobile. It was emotionally draining for me to get my hopes up on hospice then be turned down. I don't think it is worth pursuing at this time.


Tue Mar 02, 2010 8:54 am
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
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With the progression of the low RBC count, sounds like she will be bedridden, maybe soon, then would hospice come in? Maybe just a call to them with the new data would make a difference. I know what you mean about getting your hopes up, but your mom does have what sounds like a significant change in her health..... Good luck Annie and thanks for updating us. Lynn


Tue Mar 02, 2010 9:07 am
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Joined: Sat Jan 03, 2009 2:59 pm
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Annie, Sorry for the delay on my reply I am a early to bed person but to answer your question my husband had been on the Exelon for awhile before the first GI bleed, that was a major one and I really don't know if it had anything to do with the Exelon because no one ever mentioned it, he was very week and suddenly started to vomit blood and I called an ambulance as I couldn't even help him to the car for the weekness and the ambulance driver thought he had the flu but soon after arrival they discovered he was bleeding internally and later during surgery they found 11 ulcers between his throat and stomach. He recieved 5 pints of blood and was released and it happened 2 more times that yr , that had a lot to do with his spiral down plus the fractures that yr and finally the aspirations are what really took him!
But the point here no one ever ,mentioned the Exelon to me and by the time this all happened he was on Max dose of 12mg daily.

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Irene Selak


Tue Mar 02, 2010 9:59 am
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Annie,
On the hospiuce issue, I would have the doctor put in another order, things have changed , don't give up just because she was denied a month ago! Caregiver's learn to fight for our LO's needs at each turn of the illness, its the only way you get anything, it certainly won't come to you unless you go after it

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Irene Selak


Tue Mar 02, 2010 10:03 am
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Joined: Wed Dec 30, 2009 1:46 pm
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Annie, being bed-bound is NOT a hospice requirement. I've had hospice patients who were ambulatory.


Tue Mar 02, 2010 10:23 am
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Yes I agree I was still able to move my Husband with his walker when he was accepted to hospice care , that was 9 months prior to his passing!

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Irene Selak


Tue Mar 02, 2010 10:33 am
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