My mom (age 70) died last December from a GI bleed. The week before she died she had an episode of heart palpitations and tachycardia, that resulted in her going to the ER. She had a hx of Htn, Psoriatic arthritis, but no previous CAD. She was on an rx for HTN QD, and on longterm methotrexate, QD, Alleve and recent startup of Humira. At the ER her Hct was discovered to be 29. (A hct three months earlier was 40.1) Her stool was guiac positive. She was admitted and had a upper endoscopy and a colonoscopy, with the only findings that of diverticulosis. The gastroenterollogist suspected an AVM as the cause of the GI bleeding and said they would recheck her Hct in a month, and to increase the fiber in her diet. Meanwhile the Hospitalists overseeing her care had a cardiac ultrasound done with all findings normal. She was on Iron while in the hospital and was given instructions to consult with her primary care MD, the GI doctor in a month and a cardiologist. When she was discharged her hct had dropped from 29 at intake to 27. She was not given an RX for Iron. I was told that they didn't consider transfusion unless the hct was 25 or below.I have been reading up on anemia's in the and feel that her symptoms of tachycardia that started the visit to the ER were because of reduced cardiac reserve. I feel they were chasing the red herring of CAD as the cause of the tachycardia, rather than dealing with her severe anemia. She died three days after discharge from cardiac arrest secondary to a GI bleed that resulted in her Hct dropping to 18, from 27 on the day of discharge. I think they should have rechecked her hct two to three days after discharge. I think she should have gotten an iron rx at discharge. I think the GI doctor should not have planned to wait a month to confirm the exact site of her GI bleeding( he said they could do the swallowed little camera if the bleeding persisted in a month, to look at the rest of her small intestine.)
What do you think? Was she given the correct care?
Marie A. Casey-Burke, ARNP
