Monday, January 17, 2011

Ava's Bloodwork

Ava had her semi-annual blood work done in mid-December and her iron level wasn't good. Last May, her iron level was in the 6 range with normal being 13-150. I'm not sure the units of measure, but it really doesn't matter at this point. A level of 6 is low and needs to be addressed.

I started iron supplements and increased all of Ava's iron rich foods. Brewers yeast, spinach, sardines, etc... I supplemented for 2 months and then stopped when I ran out of the second bottle. I continued with the iron rich foods and just kinda assumed it was OK. She was energetic and active and was looking great.

Then we had the repeat blood work in December and her level was 2. This is considered a "dangerously low" iron level with an iron supplement needed IMMEDIATELY!

So I ran out to find the baby iron drops and couldn't find them anywhere. I ended up with the adult liquid supplement. Her dose was 15mg three times a day. With the adult iron, I needed to give her 1 ounce of liquid to reach 15mg. Iron also needs to be given with a Vitamin C source and away from calcium and meals, so I was adding 1 ounce of either apple or orange juice and giving it about 20 minutes before her tube feedings...three times a day.

Within a few days, Ava's stools started to get REALLY black and VERY soft. Iron usually constipates, but with the amount she was getting, I wasn't too surprised by her stool change. We continued the supplement and just kept our eye on her diapers.

A few days after we noticed the stool changes, I started to notice an odor. "Melena" is a medical term for stool that contains digested blood. I've smelled it a million times working with animals in the hospital and it's a smell you NEVER forget. One of those odors that just screams "PROBLEM!". It's a smell that gets burned into your brain.

The scary part about melena is that it usually indicates bleeding high up in the digestive track...the upper intestine and sometimes the stomach. My first thought...Ava was bleeding because of all the iron we're giving her. Have we given her an ulcer? Is the iron ripping up her gut? I felt a wave of panic and we immediately stopped the supplement.

I e-mailed the doctor and told her what was happening...she absolutely insisted that we continue iron supplementation because her levels were so low. I mulled it over for a day or two and realized that the melena smell was actually the iron supplement itself. We had to give such a high dose which resulted in such a high volume and the iron had kind of a "blood" smell to begin was AS IF her body was digesting "blood".

I finally found the infant iron supplement on Amazon and just bit the bullet with the crazy shipping cost. It took about a week to arrive. Meanwhile, I was searching every store I could think of to find the infant form of iron...with no luck. The good thing was that her body had some time to "recover" and her stools went back to normal and the awful melena smell went away.

The iron finally arrived and we started the supplementation protocol...again. This time, it's been fine. Ava doesn't seem to be having any side-effects other than a loose stool, and her energy and vibrance is the same as before.

So...we keep doing this until her recheck in March. 

How is it possible that this child has such low iron levels? She gets tons of iron in her food and she didn't appear to have any kind of mal-absorption issue during her last endoscopy in August. I'm not sure what the next step will be if the supplements don't work.

She's got lots of energy and is vibrant and alive. Definitely not the typical "iron-deficiency anemia" kid. However, we can't allow her to continue on with such a low level. 

We've worked the iron into her routine...we now use her tube 8 times a day and sweet little Ava has just taken it all in stride. I've decided not to get too worked up about it...yet. I might change my feeling on that after her March bloods.

I guess, like always with Ava...we just wait and see.