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Could It Be Seeping Blood From Multiple Organs, Each Of Which Is Undetectable But Which Collectively Makes For A Significant Loss Of This Vital Fluid?
Question: We have an 89 yr old friend w. multiple health issues. Heart, diabetes, only one kidney, etc. He’s losing blood and has had 2 endoscopies, 2 colonoscopies, and 2 insertions of a camera to check lower intestines. None of these has shown any source of blood loss. He’s had at least 8 units of blood over the past 3 weeks and his hemoglobin count is 9 XXXXXXX now 7.3. Could he be “seeping” blood from multiple organs, each of which is undetectable but which collectively makes for a significant loss of this vital fluid? Thank you.
Brief Answer:
there are some cases like this
Detailed Answer:
Hello,
welcome to 'Ask a Doctor' service. I've gone through your query and I'm going to present some thoughts about his case.
Before starting my answer I should note that the information you've provided is not adequate for a complete understanding of his situation. For example I've noticed that his doctors focused on the gastrointestinal system to find the cause. Did they have any signs of gastrointestinal bleeding like a positive test for occult blood or visible blood (either bright red blood or a melena)?
There are cases where blood can be lost without any external signs and may mislead the doctors. A common disorder is a femur fracture. Such fractures result in significant bleeding and the blood remains trapped inside the thigh. Sometimes the affected leg may be very swollen (and give a warning sign for the fracture and the associated bleeding). In other cases there may be minimal evidence of the event.
Another potential cause of blood 'loss' is hemolysis. Hemolysis means premature destruction of blood cells and results in low hematocrit and hemoglobin without actual blood 'leakage'. It can be detected with simple lab tests.
Bleeding from other organs would be very rare and should generally cause blatant symptoms. For example a ruptured aneurysm or a ruptured spleen may result in significant blood loss and symptoms of faintness, cold sweating, thirst, etc.
I hope I've answered your query. Let me know if you need further assistance.
Kind Regards!
there are some cases like this
Detailed Answer:
Hello,
welcome to 'Ask a Doctor' service. I've gone through your query and I'm going to present some thoughts about his case.
Before starting my answer I should note that the information you've provided is not adequate for a complete understanding of his situation. For example I've noticed that his doctors focused on the gastrointestinal system to find the cause. Did they have any signs of gastrointestinal bleeding like a positive test for occult blood or visible blood (either bright red blood or a melena)?
There are cases where blood can be lost without any external signs and may mislead the doctors. A common disorder is a femur fracture. Such fractures result in significant bleeding and the blood remains trapped inside the thigh. Sometimes the affected leg may be very swollen (and give a warning sign for the fracture and the associated bleeding). In other cases there may be minimal evidence of the event.
Another potential cause of blood 'loss' is hemolysis. Hemolysis means premature destruction of blood cells and results in low hematocrit and hemoglobin without actual blood 'leakage'. It can be detected with simple lab tests.
Bleeding from other organs would be very rare and should generally cause blatant symptoms. For example a ruptured aneurysm or a ruptured spleen may result in significant blood loss and symptoms of faintness, cold sweating, thirst, etc.
I hope I've answered your query. Let me know if you need further assistance.
Kind Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much. I appreciate that you are not in full possession of a complete history. There is no fracture. Signs of occult blood in stool - very dark.
Patient is sedentary, and as I said before has multiple health issues.
It just seemed to me that there could be multiple seepages in internal organs which could account for this steady blood loss.
Thanks. W S Armentrout.
Patient is sedentary, and as I said before has multiple health issues.
It just seemed to me that there could be multiple seepages in internal organs which could account for this steady blood loss.
Thanks. W S Armentrout.
I should have added that he is being treated at a major hospital in XXXXXXX Ga. USA by a well trained gastroenterologist and internist. Piedmont Hospital. I would think that they would have checked out the issues you mentioned.. I am not a relative, this gentleman has only one who is not in attendance.
W S Armentrout
W S Armentrout
Brief Answer:
dark stool usually originates from the upper gastrointestinal tract
Detailed Answer:
Thanks for the additional information!
When the stool looks like tar (shiny black liquid and smelly stool) then this is an indication of upper gastrointestinal bleeding. More compact black stool may also mean bleeding but not as severe as with the liquid form. Blood acts like a stool softener. The more blood in the stool, the more liquid the stool . Severe bleeding causes shiny black or maroon stool. Less serious bleeding causes dark (but still black) stool.
Sometimes the endoscopies and the capsule cannot identify the bleeding tissue. The doctors cannot do much about it. Deep enteroscopy may be an option for a more close look at the small intestine.
Perhaps an alternative approach would have been an angiography to identify a leak. This is an old method of investigating significant blood loss that's rarely used particularly nowadays. Since this seems to be a significant blood loss then perhaps the doctors could consider this method.
In many cases the underlying cause is a common lesion that - for some reasons - tends to escape detection even with repeated endoscopies.
I'm sure his doctors would do everything that's possible for him.
Best wishes for a fast recovery!
dark stool usually originates from the upper gastrointestinal tract
Detailed Answer:
Thanks for the additional information!
When the stool looks like tar (shiny black liquid and smelly stool) then this is an indication of upper gastrointestinal bleeding. More compact black stool may also mean bleeding but not as severe as with the liquid form. Blood acts like a stool softener. The more blood in the stool, the more liquid the stool . Severe bleeding causes shiny black or maroon stool. Less serious bleeding causes dark (but still black) stool.
Sometimes the endoscopies and the capsule cannot identify the bleeding tissue. The doctors cannot do much about it. Deep enteroscopy may be an option for a more close look at the small intestine.
Perhaps an alternative approach would have been an angiography to identify a leak. This is an old method of investigating significant blood loss that's rarely used particularly nowadays. Since this seems to be a significant blood loss then perhaps the doctors could consider this method.
In many cases the underlying cause is a common lesion that - for some reasons - tends to escape detection even with repeated endoscopies.
I'm sure his doctors would do everything that's possible for him.
Best wishes for a fast recovery!
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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