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Dear Doc.This Is Reg My Mother Aged 82.Past History Of

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Posted on Thu, 19 Sep 2019
Question: Dear Doc.This is reg my mother aged 82.Past history of MI 8 years back treated with medicines.No other procedures.Since then on constant monitoring.
3 days back in evening while coughing up she spitted blood in commotion blood came out thro nostrils also as she had vomitting sensation.But before this incident 15 mins back she took 3 bananas which did not come out and only phlegm and blood came out.Immediatly GP came home and checked vital parameters like BP ..pulse Sugar etc and all normal.Given IM inj of Ranitidine and ondassterone.Adv us to give Mucaine gel 2 spoons before any intake and pantocid.To watch for a day or two to note any further episodes.Whole of next day no episodes .Parallely she was given Taxim O injec.IV twice a day and till now given 6 inj so far.
Again yesterday eve.she coughed up and along with sputum which is thick...blood came out.We collected it and showed it to her. ONce only happened.After seeing it she adv to take Total count of Blood as well S Chest X ray .
Today evening reports came and following are radiologists Impression.
1)cardiomegally.
2)Bilateral Pulmonary vascular Congestion.
3)Right pleural effusion with collapse Consolidation right lower lobe.
AS far as Blood count is concerned HB is 11.9.RBC is 4.18.WBC is 5890.ESR is 38mm/hr.Neutro is 51%.Lymppho is 39%.Eososino is 06%.mono is 4%.
Also the TB test result is awaited which they said will take 3 days.
NOW WHAT DOES ALL INDICATE??? Does the above co relate anything with Coughing up blood in sputum.??
What is the treatment mode?? Options ?? Medications?
CLINICALLY no symptoms like Fever ..or any chest pain or constant cough or breathless XXXXXXX She is clinically ok except blood in sputum.Today evening also while coughing up once blood came along with sputum.
Kly adv us reg this findings above and how this has to be treated?? IS this like any pneumonia or TB.? She s vaccinated for pnemonia 4 years back .
PATIENT HAD A PAST HISTORY OF PLEURASSY AROUND 40 YEARS BACK.
KLY ADV ON HOW TO RESOLVE AND WHAT ARE TREATMENT OPTIONS AND ITS OUTCOME?? ANY FURTHER INVESTIGATIONS/imaging tests needed?? X ray taken at bed side at home and film was kept at her back in sleeping position.
She takes daily Telma 40 mg-1,Cilacar 10 mg -1.prolomet XL-25 mg once.NIcorandil 5 mg twice a day,Roseday 5 mg..clopilet 75 -1.plus multivitamins.
Awaiting reply.
How to stop is blood n sputum from coming out??
What medications etc needed??
How will be the outcome??
Best Regards.
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Follow up: Dr. Drkaushal85 (0 minute later)
Dear Doc.This is reg my mother aged 82.Past history of MI 8 years back treated with medicines.No other procedures.Since then on constant monitoring.
3 days back in evening while coughing up she spitted blood in commotion blood came out thro nostrils also as she had vomitting sensation.But before this incident 15 mins back she took 3 bananas which did not come out and only phlegm and blood came out.Immediatly GP came home and checked vital parameters like BP ..pulse Sugar etc and all normal.Given IM inj of Ranitidine and ondassterone.Adv us to give Mucaine gel 2 spoons before any intake and pantocid.To watch for a day or two to note any further episodes.Whole of next day no episodes .Parallely she was given Taxim O injec.IV twice a day and till now given 6 inj so far.
Again yesterday eve.she coughed up and along with sputum which is thick...blood came out.We collected it and showed it to her. ONce only happened.After seeing it she adv to take Total count of Blood as well S Chest X ray .
Today evening reports came and following are radiologists Impression.
1)cardiomegally.
2)Bilateral Pulmonary vascular Congestion.
3)Right pleural effusion with collapse Consolidation right lower lobe.
AS far as Blood count is concerned HB is 11.9.RBC is 4.18.WBC is 5890.ESR is 38mm/hr.Neutro is 51%.Lymppho is 39%.Eososino is 06%.mono is 4%.
Also the TB test result is awaited which they said will take 3 days.
NOW WHAT DOES ALL INDICATE??? Does the above co relate anything with Coughing up blood in sputum.??
What is the treatment mode?? Options ?? Medications?
CLINICALLY no symptoms like Fever ..or any chest pain or constant cough or breathless XXXXXXX She is clinically ok except blood in sputum.Today evening also while coughing up once blood came along with sputum.
Kly adv us reg this findings above and how this has to be treated?? IS this like any pneumonia or TB.? She s vaccinated for pnemonia 4 years back .
PATIENT HAD A PAST HISTORY OF PLEURASSY AROUND 40 YEARS BACK.
KLY ADV ON HOW TO RESOLVE AND WHAT ARE TREATMENT OPTIONS AND ITS OUTCOME?? ANY FURTHER INVESTIGATIONS/imaging tests needed?? X ray taken at bed side at home and film was kept at her back in sleeping position.
She takes daily Telma 40 mg-1,Cilacar 10 mg -1.prolomet XL-25 mg once.NIcorandil 5 mg twice a day,Roseday 5 mg..clopilet 75 -1.plus multivitamins.
Awaiting reply.
How to stop is blood n sputum from coming out??
What medications etc needed??
How will be the outcome??
Best Regards.
doctor
Answered by Dr. Drkaushal85 (9 hours later)
Brief Answer:
Stop Clopilet and get done 2d echo.

Detailed Answer:
Thanks for your question on Ask a doctor forum.
I can understand your concern.
I have gone through the detailed history you have given.
In my opinion, she is having pulmonary edema related blood in sputum (hemoptysis).
So you should follow these
1. Hold Clopilet (blood thinner)
2. Start Tablet Tranexa (to stop bleeding)
3. Consult cardiologist and get done clinical examination, ecg and 2d echo to rule out pulmonary edema (secondary to heart failure).
Her X ray findings (cardiomegaly, right pleural effusion, bilateral pulmonary vascular congestion - pulmonary edema) are classical of heart failure and this can lead to blood in sputum.
So follow the advice given above.
Hope I have solved your query. I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Drkaushal85 (0 minute later)
Brief Answer:
Stop Clopilet and get done 2d echo.

Detailed Answer:
Thanks for your question on Ask a doctor forum.
I can understand your concern.
I have gone through the detailed history you have given.
In my opinion, she is having pulmonary edema related blood in sputum (hemoptysis).
So you should follow these
1. Hold Clopilet (blood thinner)
2. Start Tablet Tranexa (to stop bleeding)
3. Consult cardiologist and get done clinical examination, ecg and 2d echo to rule out pulmonary edema (secondary to heart failure).
Her X ray findings (cardiomegaly, right pleural effusion, bilateral pulmonary vascular congestion - pulmonary edema) are classical of heart failure and this can lead to blood in sputum.
So follow the advice given above.
Hope I have solved your query. I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Drkaushal85 (1 hour later)
Doc.Thanx a lot.
1)Our GP has started Tranexa 500 mg tablet daily twice a day.Wt is the ideal dosage abd how long to be given?
2) we shall stop Clopilet.As per her Blood count her platelets are 1.7 L.Is this right??
3) while we are scheduling visit with Cardio...GP has adv to continue Taxim IV inj for another 5 days to prevent infection.
4) Is this also Pleurassy???
5) Wt is the role of NICORANDIL in this condition?? SHD WE continue??
Pl clarify on above.Best Regards.r
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Follow up: Dr. Drkaushal85 (0 minute later)
Doc.Thanx a lot.
1)Our GP has started Tranexa 500 mg tablet daily twice a day.Wt is the ideal dosage abd how long to be given?
2) we shall stop Clopilet.As per her Blood count her platelets are 1.7 L.Is this right??
3) while we are scheduling visit with Cardio...GP has adv to continue Taxim IV inj for another 5 days to prevent infection.
4) Is this also Pleurassy???
5) Wt is the role of NICORANDIL in this condition?? SHD WE continue??
Pl clarify on above.Best Regards.r
doctor
Answered by Dr. Drkaushal85 (57 minutes later)
Brief Answer:
Yes, continue with Nicorandil.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.

Answer to your 1st question.

There is no ideal dose for Tranexa. Maximum dose is thrice daily (1500mg). So you can give maximum 3 tablets in a day.

Answer to your 2nd question.

Stop Clopilet. And her platelets are slightly low. No need to worry but get done repeat platelet count after 1-2 days.

Answer to your 3rd question.

Yes, continue with Taxim injection.

Answer to your 4th question.

No, I don't think it is pleurisy.

Answer to your 5th question.

Nicorandil should be continued as cardioprotective.

Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Drkaushal85 (0 minute later)
Brief Answer:
Yes, continue with Nicorandil.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.

Answer to your 1st question.

There is no ideal dose for Tranexa. Maximum dose is thrice daily (1500mg). So you can give maximum 3 tablets in a day.

Answer to your 2nd question.

Stop Clopilet. And her platelets are slightly low. No need to worry but get done repeat platelet count after 1-2 days.

Answer to your 3rd question.

Yes, continue with Taxim injection.

Answer to your 4th question.

No, I don't think it is pleurisy.

Answer to your 5th question.

Nicorandil should be continued as cardioprotective.

Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Drkaushal85 (2 days later)
Doc. We did meet our Cardio who treats her reg after her MI for last 9 years.reg this episode.He had also gone thro ECHO which I am Uploading.As per him Considering age and past history nothing abnormal or heart failure situation etc.He says EF of 43% is what is expected .After seeing the blood pics etc which spitted..he is off the opinion that there could a minor vessel rupture in the broncheo spaces which cld hv hpnd instantaenously also while sudden high cough bout as there was no other earlier symptoms like breathing ..fever or pain etc.He said we shd hv continued Tab TRANEXA 2 TIMES DAILY FOR 1 WK and to stop clopilet which anyway we had done.He was the opinion that since X ray taken on home visit using XXXXXXX X rays image resolution s bad in nature and was not keen to read the report also..though he saw the film.He also suggested us to continue TAXIm In inj for 5 days twice a day.Tranexa twice a day for 7 days.To stop clopilet till resolves.He adv us to monitor BP and to keep it under tight control .He said on continuing with Tranexa twice a say blood shd stop .He was also of the view that this can neither b pleurisy nor pneumonia since no other clinical symptoms.When I said ESR is high...he said dat alone cannot be the criteria since WBC diff are very normal.IS DAT RIGHT?
HE adv us to continue Nicorandil..Telma 40 Cilcar 10 mg and prolomet XL 25.twice a day.He asked us to add Pulmoclear syrup twice a day .
IS THE ABOVE LINE OF ACTION RIGHT??
SINCE YESTERDAY MORNING TILL NOW ONLY ONCE WHEN SHE SPITTED THERE WAS A SLIGHT BLOOD.
KLY ADV FURTHER.
WOULD A CT SCAN OF LUNG GIVE CLEAR PICTURE OF ANY VESSEL RUPTURING??
ENCLOSING ECHO REPORTS TOO.
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Follow up: Dr. Drkaushal85 (0 minute later)
Doc. We did meet our Cardio who treats her reg after her MI for last 9 years.reg this episode.He had also gone thro ECHO which I am Uploading.As per him Considering age and past history nothing abnormal or heart failure situation etc.He says EF of 43% is what is expected .After seeing the blood pics etc which spitted..he is off the opinion that there could a minor vessel rupture in the broncheo spaces which cld hv hpnd instantaenously also while sudden high cough bout as there was no other earlier symptoms like breathing ..fever or pain etc.He said we shd hv continued Tab TRANEXA 2 TIMES DAILY FOR 1 WK and to stop clopilet which anyway we had done.He was the opinion that since X ray taken on home visit using XXXXXXX X rays image resolution s bad in nature and was not keen to read the report also..though he saw the film.He also suggested us to continue TAXIm In inj for 5 days twice a day.Tranexa twice a day for 7 days.To stop clopilet till resolves.He adv us to monitor BP and to keep it under tight control .He said on continuing with Tranexa twice a say blood shd stop .He was also of the view that this can neither b pleurisy nor pneumonia since no other clinical symptoms.When I said ESR is high...he said dat alone cannot be the criteria since WBC diff are very normal.IS DAT RIGHT?
HE adv us to continue Nicorandil..Telma 40 Cilcar 10 mg and prolomet XL 25.twice a day.He asked us to add Pulmoclear syrup twice a day .
IS THE ABOVE LINE OF ACTION RIGHT??
SINCE YESTERDAY MORNING TILL NOW ONLY ONCE WHEN SHE SPITTED THERE WAS A SLIGHT BLOOD.
KLY ADV FURTHER.
WOULD A CT SCAN OF LUNG GIVE CLEAR PICTURE OF ANY VESSEL RUPTURING??
ENCLOSING ECHO REPORTS TOO.
doctor
Answered by Dr. Drkaushal85 (10 minutes later)
Brief Answer:
Yes, treatment is appropriate.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
Yes, the suggested treatment is appropriate.
And simple CT scan can not detect leak in blood vessels.
For this purpose, you need CT pulmonary angiography.
But in my opinion, no need for CT scan at present.
Wait for 1-2 weeks more.
I will be happy to help you further. Wishing good health to your mother. Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Drkaushal85 (0 minute later)
Brief Answer:
Yes, treatment is appropriate.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
Yes, the suggested treatment is appropriate.
And simple CT scan can not detect leak in blood vessels.
For this purpose, you need CT pulmonary angiography.
But in my opinion, no need for CT scan at present.
Wait for 1-2 weeks more.
I will be happy to help you further. Wishing good health to your mother. Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Drkaushal85 (41 hours later)
Dear doctor
further to the above would like to inform you that by today evening the 5 day IV TAXIM O INJ is getting over.
Our GP suggesting to take a Blood count test and also repeat Chest X ray AP since 5 day IV of
Taxim Twice a day is over by evening .Is this correct to do?? Or can it b done later?
Also she s suggesting to add Azee 500 mg tablet once a day for another 5 days from tomorrow.Clinical pic is fine so far.
Pl suggest.
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Follow up: Dr. Drkaushal85 (0 minute later)
Dear doctor
further to the above would like to inform you that by today evening the 5 day IV TAXIM O INJ is getting over.
Our GP suggesting to take a Blood count test and also repeat Chest X ray AP since 5 day IV of
Taxim Twice a day is over by evening .Is this correct to do?? Or can it b done later?
Also she s suggesting to add Azee 500 mg tablet once a day for another 5 days from tomorrow.Clinical pic is fine so far.
Pl suggest.
doctor
Answered by Dr. Drkaushal85 (20 minutes later)
Brief Answer:
Yes, get done repeat chest x ray tomorrow.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
Yes, get done repeat chest x ray tomorrow.
Continue Taxim O injection till tomorrow.
If chest x ray is improving then better to give Tablet Cefixime (similar to injection Taxim).
So please let me know tomorrow chest x ray.
I will be happy to help you further. Wishing good health to your mother. Thanks.
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Drkaushal85 (0 minute later)
Brief Answer:
Yes, get done repeat chest x ray tomorrow.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
Yes, get done repeat chest x ray tomorrow.
Continue Taxim O injection till tomorrow.
If chest x ray is improving then better to give Tablet Cefixime (similar to injection Taxim).
So please let me know tomorrow chest x ray.
I will be happy to help you further. Wishing good health to your mother. Thanks.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Dear Doc.This Is Reg My Mother Aged 82.Past History Of

Dear Doc.This is reg my mother aged 82.Past history of MI 8 years back treated with medicines.No other procedures.Since then on constant monitoring. 3 days back in evening while coughing up she spitted blood in commotion blood came out thro nostrils also as she had vomitting sensation.But before this incident 15 mins back she took 3 bananas which did not come out and only phlegm and blood came out.Immediatly GP came home and checked vital parameters like BP ..pulse Sugar etc and all normal.Given IM inj of Ranitidine and ondassterone.Adv us to give Mucaine gel 2 spoons before any intake and pantocid.To watch for a day or two to note any further episodes.Whole of next day no episodes .Parallely she was given Taxim O injec.IV twice a day and till now given 6 inj so far. Again yesterday eve.she coughed up and along with sputum which is thick...blood came out.We collected it and showed it to her. ONce only happened.After seeing it she adv to take Total count of Blood as well S Chest X ray . Today evening reports came and following are radiologists Impression. 1)cardiomegally. 2)Bilateral Pulmonary vascular Congestion. 3)Right pleural effusion with collapse Consolidation right lower lobe. AS far as Blood count is concerned HB is 11.9.RBC is 4.18.WBC is 5890.ESR is 38mm/hr.Neutro is 51%.Lymppho is 39%.Eososino is 06%.mono is 4%. Also the TB test result is awaited which they said will take 3 days. NOW WHAT DOES ALL INDICATE??? Does the above co relate anything with Coughing up blood in sputum.?? What is the treatment mode?? Options ?? Medications? CLINICALLY no symptoms like Fever ..or any chest pain or constant cough or breathless XXXXXXX She is clinically ok except blood in sputum.Today evening also while coughing up once blood came along with sputum. Kly adv us reg this findings above and how this has to be treated?? IS this like any pneumonia or TB.? She s vaccinated for pnemonia 4 years back . PATIENT HAD A PAST HISTORY OF PLEURASSY AROUND 40 YEARS BACK. KLY ADV ON HOW TO RESOLVE AND WHAT ARE TREATMENT OPTIONS AND ITS OUTCOME?? ANY FURTHER INVESTIGATIONS/imaging tests needed?? X ray taken at bed side at home and film was kept at her back in sleeping position. She takes daily Telma 40 mg-1,Cilacar 10 mg -1.prolomet XL-25 mg once.NIcorandil 5 mg twice a day,Roseday 5 mg..clopilet 75 -1.plus multivitamins. Awaiting reply. How to stop is blood n sputum from coming out?? What medications etc needed?? How will be the outcome?? Best Regards.