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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 55454
Experience:  GP in the United States
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I have a really urgent question. We have a 21-year-old German

Customer Question

I have a really urgent question. We have a 21-year-old German girl Au Pair staying with us and she is having severe menstrual bleeding. She's had it for 11+ days now and on Monday it started to get much heavier, the blood is thin and she passes clots. She is using tampons and pads and has to change every 30-45 minutes. She is very pale and feels extremely weak (she really does not look well and she is normally very fit and healthy). She is on blood thinning medication Xarelto® (rivaroxaban) 20mg as she had a double pulmonary embolism last May.
She only told me about it yesterday and I took her to the GP who didn't have time yesterday and sent us to a walk-in centre, where we saw another doctor, who, after taking her history, told us to go to A&E dept for blood tests and investigations. We were at the hospital from 9pm until 6am and saw an A&E doctor, she had blood tests (all look ok, HB & RBC a little low but no concerns, clotting all ok; BP 100/70ish, pulse 60-70bpm last night). She then saw an ObGyn who said there was nothing they could do for her, just hope the bleeding will stop by itself. Apparently they could not give her whatever they would normally give in these circumstances if she was on another medicine, and they don't want to stop the Xarelto as that could risk another embolism. The only thing they said was that if it keeps going for the next days she may need to go back and have a blood transfusion.
As she is effectively in my care, I really want to make sure everything is being done to keep her safe and well. So I am asking for a second opinion please. Plus any other info that could be helpful - i.e. how to change her diet, supplements etc. She is now on bed rest and I will make sure she drinks plenty. But would really want to know what else we can do please!
She is really looking very unwell and pale and she barely moves about and thinks her BP is low now too.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 3 years ago.
Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

Thanks for this question

Unfortunately there is not much that can be done here. The xarelto is needed to prevent blood clots but at the same time she is having heavy menstrual bleeding.

The key thing to consider is that the blood counts done in A and E might be falsely elevated.

If you check blood counts too close to the time of bleeding, they won't be low because the blood hasn't had time to thin out.

I recommend close monitoring of blood counts.

She simply needs to rest. No heavy lifting, no activity.

Anything strenuous will likely make the bleeding worse.

Customer: replied 3 years ago.

Thank you so much. At the moment she also started using my supplement Ferroglobin Plus (for Iron and energy) and as I said, I had told her to stay in bed. Is there anything else she/we can do to help her body cope better? And second question, at what point should we get help? Thank you again!

Expert:  Dr. Phil, MD replied 3 years ago.
That is a reasonable supplement to take

No, just rest and stay hydrated. The water can replace lost blood from a fluid standpoint

I would get help if she continues to bleed
Dr. Phil, MD and other Medical Specialists are ready to help you
Customer: replied 3 years ago.

Thank you so much for your prompt answer and help, very much appreciated!

Expert:  Dr. Phil, MD replied 3 years ago.
I appreciate the excellent rating.

I would be happy to help you in the future. Just ask for feedback. Thank you. :) Dr. Phil in your question opening or bookmark this page http://www.justanswer.co.uk/medical/expert-irondoc/

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