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What Causes Debilitating Chronic Fatigue And Nausea?
Posted on
Sun, 25 Oct 2015
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sun, 25 Oct 2015
Answered on
Thu, 12 Nov 2015
Last reviewed on
Question : For the last few years, my 79 year old wife has been suffering from debilitating chronic fatigue and nausea. Numerous tests over the last few years have shown no physical cause of her condition. However, in the last few months the word "blood" has come up in her latest doctor and hospital visits.
In July she broke her femur and was admitted to the hospital where her HGB count was 9.8 and there was discussion about giving her a blood transfusion. It later went to 10.5 and the transfusion was not administered. In the last two months she has been to the doctor/hospital because of blood in her ileostomy bag. Detecting no blood in her stool, it was determined the blood in the bag was a result of her being on the prescription drug Xarelto.
Since doctors see the results of individual blood tests to made their decisions, I decided to do a records search of past results to see if there is a trend. Following are her last 10 CBC test results.
Date: 7/13 7/15 7/22 8/22 8/28 10/18 10/19 10/19 10/20 10/21
HCT 29.6(L) 29.2(L) 32.3(L) 36.5 42.7 39.9 34.1(L) 37.5 32.8(L 33.3(L)
HGB 9.8(L) 9.6(L) 10.5(L) 11.6(L) 13.6 12.7 11.0(L) 11.7(L) 10.4(L) 10.6(L)
On 10/18 her PT/INR was 29.4(H) and her APTT was 42(H)
My question, based on the above information, should she schedule a consult with a hematologist to see if there is a blood/fatigue relationship?
In July she broke her femur and was admitted to the hospital where her HGB count was 9.8 and there was discussion about giving her a blood transfusion. It later went to 10.5 and the transfusion was not administered. In the last two months she has been to the doctor/hospital because of blood in her ileostomy bag. Detecting no blood in her stool, it was determined the blood in the bag was a result of her being on the prescription drug Xarelto.
Since doctors see the results of individual blood tests to made their decisions, I decided to do a records search of past results to see if there is a trend. Following are her last 10 CBC test results.
Date: 7/13 7/15 7/22 8/22 8/28 10/18 10/19 10/19 10/20 10/21
HCT 29.6(L) 29.2(L) 32.3(L) 36.5 42.7 39.9 34.1(L) 37.5 32.8(L 33.3(L)
HGB 9.8(L) 9.6(L) 10.5(L) 11.6(L) 13.6 12.7 11.0(L) 11.7(L) 10.4(L) 10.6(L)
On 10/18 her PT/INR was 29.4(H) and her APTT was 42(H)
My question, based on the above information, should she schedule a consult with a hematologist to see if there is a blood/fatigue relationship?
Brief Answer:
CBC results show anemia, anemia cause of fatigue.
Detailed Answer:
Hello,
Thanks for posting your query on HealthcareMagic.
The CBC results show that your wife is suffering from anemia.
Anemia or low hemoglobin leads to decreased ability of the hemoglobin to deliver enough oxygen to body tissues which results in easy fatigubility.
I suggest you to get peripheral blood examination done to know the type of anemia.
There are different kinds of anemia and the management is done on the basis of type of anemia.
Secondly PT and aPTT are high.
This is because your wife is taking medicine Xarelto which is an anti-thrombotic agent.
Anti-thrombotic treatment is being given to your wife for prevention of deep vein thrombosis which can occur during immobilization as required after a femur fracture.
When on anti-thrombotic treatment the INR should be maintained between 2-3.
If you have more concerns, I will be glad to address.
Thanks and take care
Dr Shailja Puri
CBC results show anemia, anemia cause of fatigue.
Detailed Answer:
Hello,
Thanks for posting your query on HealthcareMagic.
The CBC results show that your wife is suffering from anemia.
Anemia or low hemoglobin leads to decreased ability of the hemoglobin to deliver enough oxygen to body tissues which results in easy fatigubility.
I suggest you to get peripheral blood examination done to know the type of anemia.
There are different kinds of anemia and the management is done on the basis of type of anemia.
Secondly PT and aPTT are high.
This is because your wife is taking medicine Xarelto which is an anti-thrombotic agent.
Anti-thrombotic treatment is being given to your wife for prevention of deep vein thrombosis which can occur during immobilization as required after a femur fracture.
When on anti-thrombotic treatment the INR should be maintained between 2-3.
If you have more concerns, I will be glad to address.
Thanks and take care
Dr Shailja Puri
Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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