We didn’t realize just how ill my mother was. As my mother walked into the emergency department, her shockingly low hemoglobin (Hb) level was 3.5 g/dL. Normal hemoglobin levels for a woman range from 12.0 to 16.0 g/dL. The nurse confided that she had never seen such low hemoglobin in a person who was conscious much less alert and ambulatory (however weak). The doctor said that such a low Hb level could cause a heart attack.
Hemoglobin is the protein molecule in red blood cells which carries oxygen throughout the body. According to the Mayo Clinic, “a low hemoglobin count is a common blood test result. In many cases, a low hemoglobin count is only slightly lower than normal, isn't considered significant, and causes no symptoms. A low hemoglobin count can also be caused by an abnormality or disease. In these situations, a low hemoglobin count is referred to as anemia.”
After an endoscopy, it was determined that bits and pieces of the large amount of Motrin which my mother had taken during the previous week for a case of sciatica likely got “stuck” in the intestines and burned small holes through the lining. The gastroparesis caused by my mother’s scleroderma is likely to blame for the Motrin’s lack of movement through the gastrointestinal track. It took four units (or one-half gallon) of blood to bring my mother’s hemoglobin level up to a safer 10.4 g/dL before she was released to go home.
An endoscopy is a gastrointestinal exam which allows the doctor to view the lining of the digestive tract. For an endoscopy, a flexible tube with a light and small camera is inserted through the throat to exam the esophagus, stomach, and duodeum (upper part of the small intestines). For a colonoscopy, a small camera is inserted through the rectum to exam the colon and large intestines.
Chronic Bleeding and Autoimmune Disease: GAVE Syndrome
My mother began to feel much, much better when her severe anemia was helped by the four units of blood she received during that first hospital visit in October 2010. However, during the following 12 months, she found herself in the hospital two more times to receive additional units of blood.
Something else was going on besides bleeding ulcers, but the doctors were not exactly sure what that was…..until her last hospitalization. After more testing with a traditional endoscopy and an endoscopy/colonoscopy conducted with a tiny camera which was swallowed, a new gastroenterologist diagnosed a condition called Gastric Antral Vascular Ectasia or GAVE syndrome.
Gatric antral vascular ectasia is an uncommon cause of gastrointestinal bleeding which is sometimes called “watermelon stomach” due to the appearance of the lesions found in the stomach. It can present symptomatically as iron-deficiency anemia, due to chronic slow bleeding, which is resistant to treatment with iron building strategies. Patients may become dependent upon blood transfusions.
