213. Deadly Combination

At 24 Melissa found herself in a dangerous situation.  She has experienced a life-long near absence of platelets--those blood components that help blood clot, important since small vascular tears are common and without some self-clotting mechanism, we'd bleed to death from a simple bump, bruise or scratch.

The normal platelet count ranges in the low hundred-thousands; mine was measured in January: 218,000--just right.  Melissa platelets hover between 2 and 5 thousand.

Second, she has experienced deep vein thrombosis, where a clot somehow did form (who knows how that happened) then broke off and obstructed some pulmonary vessels (pulmonary embolism).  These traveling blood clots ("DVTs") can also cause heart attacks and strokes. 

And finally, her menses started and just wouldn't stop (the low platelet thing).  Many of the medicines used for heavy menses can't be used because they increase the risk of stroke (having had one DVT means a rest-of-your-life risk for having another). 

In the hospital, she received fluids, and both whole blood and platelet transfusions, and my group was consulted, resulting in recommendation for progesterone pills--a hormone that can stop bleeding without--in theory at least--increasing the risk of.  The initial dose wasn't helping, so when I was on call I recommended doubling the dose.  A few days later one of my partners doubled it again, which is what I would have done.  That seemed to help--the bleeding almost completely stopped

A few days after that, still in the hospital, she coded and could not be resuscitated, a presumed fatal pulmonary embolism.