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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Internal Bleeding In Elderly People?

My 86 year old mom has anemia due to AVM that they cauterized a month ago. She tested positive for occult bleeding so they did another endoscopy and found another AVM in the duodenum area when they cauterized the new one the old one burst and they fixed it and stopped both visual bleeds. Her colonoscopy was fine no cancer ect... What underlining disease could be causing her internal bleeding? They wanted to do the camera swallow pill to look at her small intestine. What the reasoning to have this procedure? She can not have a surgery, because she has anemia and low red blood counts. Last blood test was: calcium11.8. RBC 3.5hemoglobin is 9.8 WBC normal and platelets at 205. Her last endo and colonoscopy was 4 weeks ago , and 8 weeks ago was her first endoscopy because her hemogloblin was 7.0 and she had blood transfusion after they cauterized a bleed. Besides being Old there has to be a reason why you get internal bleeds? She doesn t drink or take NSAIDs etc...It seems like many older people get anemic?
Mon, 16 Mar 2015
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Psychiatrist 's  Response
Hello,
Welcome to Health Care Magic.
Thanks for posting your question at this forum.
We understand your concern.
I am Dr Alok Sinha, MD Psychiatry from India.
I will try to help you.

There are many factors that lead to anaemia in old age. The main reasons are:-
1. Hemorrhage (leaking of blood from blood vessels)
2. Hemolysis (breakdown of Red Blood Cells)
3. Reduced blood cell formation due to nutritional factors and deranged renal function.

Here in your mom's case, as you told, anaemia is mainly because of blood loss due to hemorrhage from AVM. Now let me educate you a little about this condition.
AVM (Arterio Venous Malformation) is a type of anatomical variation in blood vessels which may lead to thinning and weakening of blood vessel wall.

Old age brings several changes to blood vessels as described below:-
1. With advance of age elasticity of blood vessel is lost, so blood vessel cannot expand when heart pumps blood into them; thus causing increased blood pressure in blood vessels (high BP).
2. Due to age related wear and tear, the wall of blood vessels become thin and weak. This affects worst at the site of AVM as because of pre-existing defect.
3. Due to weak vessel wall and increased BP the wall may rupture easily and this leads to sudden hemorrhage and anaemia.
This is apparently happening in your mother’s case. Then why is this happening at multiple places one after another? The answer lies in following lines.
AVMs exist since birth. There may be multiple AVM. If blood pressure is poorly controlled AVM may bleed easily. Cauterizing an AVM point is certainly required to stop the bleed but it does not stops other AVM site from bleed in future in case of increased blood pressure.
Camera swallow pill may detect AVM at GI tract only, but what about the AVM of other parts of body like brain and liver?

If an elderly person like your mother would have come to me with similar problem, I would have suggested following things:-

1. Regular BP monitoring.
2. Proper dosing of antihypertensive medication to avoid any surge in BP.
3. Minimum/no exertion, avoid heightened emotions and anxiolytics if needed to avoid phases of excitement (and thus reducing the chance of raised BP).
4. Get the kidney function test, liver function test and Hb checked regularly.
5. Low salt diet.
You may consult a good physician who may prescribe your mother a suitable antihypertensive medicine in right doses and you may discuss your mother's health on these issues.


Hope this answers your question. I wish your mother a better health.
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What Causes Internal Bleeding In Elderly People?

Hello, Welcome to Health Care Magic. Thanks for posting your question at this forum. We understand your concern. I am Dr Alok Sinha, MD Psychiatry from India. I will try to help you. There are many factors that lead to anaemia in old age. The main reasons are:- 1. Hemorrhage (leaking of blood from blood vessels) 2. Hemolysis (breakdown of Red Blood Cells) 3. Reduced blood cell formation due to nutritional factors and deranged renal function. Here in your mom s case, as you told, anaemia is mainly because of blood loss due to hemorrhage from AVM. Now let me educate you a little about this condition. AVM (Arterio Venous Malformation) is a type of anatomical variation in blood vessels which may lead to thinning and weakening of blood vessel wall. Old age brings several changes to blood vessels as described below:- 1. With advance of age elasticity of blood vessel is lost, so blood vessel cannot expand when heart pumps blood into them; thus causing increased blood pressure in blood vessels (high BP). 2. Due to age related wear and tear, the wall of blood vessels become thin and weak. This affects worst at the site of AVM as because of pre-existing defect. 3. Due to weak vessel wall and increased BP the wall may rupture easily and this leads to sudden hemorrhage and anaemia. This is apparently happening in your mother’s case. Then why is this happening at multiple places one after another? The answer lies in following lines. AVMs exist since birth. There may be multiple AVM. If blood pressure is poorly controlled AVM may bleed easily. Cauterizing an AVM point is certainly required to stop the bleed but it does not stops other AVM site from bleed in future in case of increased blood pressure. Camera swallow pill may detect AVM at GI tract only, but what about the AVM of other parts of body like brain and liver? If an elderly person like your mother would have come to me with similar problem, I would have suggested following things:- 1. Regular BP monitoring. 2. Proper dosing of antihypertensive medication to avoid any surge in BP. 3. Minimum/no exertion, avoid heightened emotions and anxiolytics if needed to avoid phases of excitement (and thus reducing the chance of raised BP). 4. Get the kidney function test, liver function test and Hb checked regularly. 5. Low salt diet. You may consult a good physician who may prescribe your mother a suitable antihypertensive medicine in right doses and you may discuss your mother s health on these issues. Hope this answers your question. I wish your mother a better health.