I am concerned that my mom may have a blood disorder. Kindly help.

Question

Hi doctor,

I am concerned that my mother may have an undiagnosed blood disorder. Can you let me know if her symptoms are anything that can be related to any blood disorder? She is 54 years old. Her weight is 143 lbs. There is no history of cardiac problems or diabetes. She is relatively healthy and eats a nutritious diet. She has had eight normal deliveries and hemorrhaged badly during her last four deliveries. Her last delivery required significant medical intervention to cease hemorrhaging. She was advised not to have more children as she would be unlike to survive another birth due to severe hemorrhaging. She has never required a blood transfusion.

Family history includes a grandmother with ovarian cancer, and her mother is obese with diabetes and cardiac complications. Her past medical history includes easy hemorrhages and anemia. She always bleeds easily and has always bruised very easily, and it takes a long time to disappear. She is taking Iron supplements to manage anemia. Recently, I massaged her aching leg, and immediately after, her thighs became brown, and it disappeared within 24 hours. Often, she gets aching legs. She was investigated for venous incompetence recently, and no DVT was found.

A few weeks ago, she developed a sudden onset of blurred vision in her right eye, sharp pain behind her eye, and vision loss. Then, she was diagnosed with central retinal venous occlusion, for which she is now under treatment and got her first eye injection last week. She has been told that they do not know the reason for CRV, as there is no predisposing risk factor. Stress echocardiogram was normal, as were her INR and APTT. Doctors are unable to explain the reason, but she is still bleeding inside her eye. It has become worse, and she is developing more symptoms, including pain and a slight droop in that eye.

My dad and I have always thought that she may have an undiagnosed blood disorder, as many things do not add up, and no doctors have been able to establish a cause for any of this. Years ago, a GP told mum that her blood was not sticky enough, but I do not know if he said this on some blood tests he may have done. We are very concerned and will probably request a referral to a hematologist. Can any sense be made from the above symptoms?

I appreciate any help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Based on your query, my opinion is as follows:

There appears to be no hematologic disorder, as tests are normal (attachment removed to protect patient identity).
Swelling in the legs could be due to varicose veins, causing fluid accumulation.
Central retinal vein occlusion can occur due to multiple causes, and it could be more local in nature. All other locations appear uninvolved, hence thinking local.
Local causes can be arteriosclerotic changes in the central retinal artery or may be an associated arterial disease with central retinal vein occlusion (CRVO).
Thrombotic occlusion of the central retinal vein can occur as a result of various pathologic insults, including compression of the vein due to mechanical pressure due to structural changes in lamina cribrosa, for example, glaucomatous cupping, inflammatory swelling in the optic nerve and orbital disorders, hemodynamic disturbances (associated with hyperdynamic or sluggish circulation), and vessel wall changes, for example vasculitis.
I am not thinking of a hematological cause; however, I do suggest meeting the hematologist for a physical evaluation.

I hope this helps you.

Take care.