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Dr. S
Dr. S , Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 191
Experience:  Board Certified in Pediatrics and Pediatric Intensive Care
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My daughter was spitting up blood for 7mths the doctors did

Customer Question

My daughter was spitting up blood for 7mths the doctors did a ct scan,blood tests,ENT and she had a Bronchoscpy. All the above tests were done in one day apart from the Bronchoscopy which she had 5mths into her illness and all showed nothing.We now have a court case pending and i was wondering if the blood specimens i have kept in the fridge would be able to be tested they are now 2yrs old, if so where would i go?
Submitted: 6 years ago.
Category: Pediatrics
Expert:  Dr. S replied 6 years ago.
It will depend on what tests are to be performed on the specimens. Typically, most laboratories will not accept a specimen that is this old and not stored in a laboratory. If the specimen is important for a forensic case, a forensic laboratory may run the specimen depending on the test and circumstances of the case itself. In that case, I would have your attorney see if that would be possible.
Customer: replied 6 years ago.
Thankyou for your reply.The information you provided me did not give me the help that i needed.If you would be able to help me with answers to my daughters illness then i would be willing to pay the amount quoted.My child was 10yrs old when she began having problems with pains in her chest she was given several courses of antibiotics over a 4mth period with the diagnosis of Bronchitus and lung infections and then asthma.My child then began to spit up small amounts of blood,this continued for 6 days she then became very unwell with chest pain and feeling extremely Lethargic she began vomiting up large amounts of blood approx 3ltr she was obviously hospitalised we were told she was having a severe Bronco spasm.They did a CT scan and chest x.ray,checked her bloods all showed nothing she was referred to ENT and they found nothing wrong.My child continued to spit up this blood everyday for 7mths.Why?
Expert:  Dr. Gupta replied 6 years ago.
Hi,
It is very unlikely that a 2 year old refrigerated sample would be good for any specific test other than a DNA analysis in this situation.
It would probably not be helpful in establishing the cause of the bleeding in this case,
What is her present status?
Hope this helps.
Expert:  Dr. S replied 6 years ago.
The main question is where is the source of the bleeding. Was the blood coming from her GI tract or was it coming from her lungs. If the blood was coming from her lungs, a bronchoscopy by ENT usually does not reveal much because they are only able to visualize the large main airways unless the bleeding was in the main trachea or bronchus and this is rare. The bleeding in those cases are usually much farther down in the smaller branches of the airway tree and are typically related to erosion of the pulmonary blood vessels. This could be due either to infection or to abnormally formed vessels that are prone to bleeding. A CT scan of the chest may reveal this if the vessels are continuing to bleed. If the bleeding had already stopped, a contrast CT of the chest may not reveal the source of the bleeding even if it had started in the chest. This is because if the vessels have already clotted off and the bleeding stopped, the CT would miss the abnormality. The other possibility is for the bleeding to be coming from the GI tract. Did they perform an endoscopy? The amount of bleeding that she had is often seen in patients with gastrointestinal bleeds. Anything from esophageal varices to gastric ulcers can give you this amount of bleeding. The best way to diagnose if this was the issue is for a gastroenterologist to scope down the esophagus and to the stomach to look for erosions and active bleeding. Chest pain can also be a common symptom in this type of illness even if the bleeding is not from lung but from the GI tract.

Now as for the severe bronchospasm, it is extremely unlikely that bronchospasm is the cause of that much blood loss.

Besides trying to find the site of bleeding, she also needs to have some baseline coagulation studies performed and liver function tests performed if that has not already been done. These will test to see if she is more prone to bleeding.

Edited by Dr. S on 5/25/2010 at 1:21 PM EST
Customer: replied 6 years ago.

Thankyou so much for your reply.She did have an endoscopy done.The consultant didnt refer her to a gastoenteroligist as he said the blood didnt indicate it came from the stomach.She did have a Bronchoscopy done and the report was there was nothing wrong with the lungs save for mild asthma.I have to say my daughter hasn't produced this blood for almost two years now but she still has from time to time problems with her asthma, she doesnt present as a normal ashmatic in that she still talks normal and appears okay, yet on examination she is most times in need of Nebulisers and steroids.It was Suggested once that she may have GoodPastures Syndrome but it was never fully investigated.I have been told that a chap in America had the same symptoms as my child,that also stopped after several months only to resurface 2yrs later with serious kidney problems.Obviously we are afraid that if this is true our childs bleeding may resurface,because why did it just stop after 7mths?

 

Expert:  Dr. S replied 6 years ago.
Well, the issues with acute lung injury in cases like good pastures or even different types of vasculitis is that there will be periods of illness as well as periods of relative stability. When a patient with these illnesses have a secondary illness, it usually affects them more severely and may trigger a severe response such as the bleeding that your daughter suffered. The diagnosis of Good Pastures syndrome and vasculitis is made by a diagnosis of biopsy. The ideal tissue to biopsy is the lung. Occasionally a kidney biopsy can reveal the diagnosis but in patients with predominant lung disease, the area of largest yield will be to biopsy the lung. Prior to doing this though it is highly recommended for her to first see a pediatric rheumatologist. They can help determine whether her symptoms and history are consistent with the diseases so to avoid unnecessary surgery if possible. It is common to see undiagnosed patients of Good pastures and Vasculopathies who have had the diagnosis of severe asthma. As for if her symptoms may occur again, if she does have good pastures or a vasculitis then the likelihood is high. These disease are treated with high dose steroids and immunosuppresants. I would speak to your pediatrician or pulmonologist about these concerns to get a referral to see a rheumatologist. They may be able to further help tease out a diagnosis and coordinate the workup that can help you get some answers.
Dr. S, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 191
Experience: Board Certified in Pediatrics and Pediatric Intensive Care
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