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Thursday, 2 August, 2001, 14:35 GMT 15:35 UK
Consultant quizzed on Queen Mother's health
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The Queen Mother is due to leave hospital soon following a blood transfusion.

She was admitted to the hospital on Wednesday, suffering from anaemia.

Royal aides insist the 100-year-old, who celebrates her 101st birthday on Saturday, is not seriously ill.

How serious is her complaint? What does the treatment involve? Will she still be able to take part in her birthday celebrations at the weekend?

Send your questions to Dr David Black, a consultant geriatrician at Queen Mary's Hospital in Sidcup and a member of the British Geriatrics Society. He answered a selection of your questions in a live forum.


Transcript:


Newshost:

The Queen Mother is due to be released from hospital later today after receiving a blood transfusion for anaemia. With me today to answer your questions about her health is Dr. David Black who is a consultant geriatrician from St. Mary's Hospital in Sidcup. He is speaking on behalf of the British Geriatric Society. Dr. Black before we start, we should just establish you are not one of the Queen Mother's doctors?


Dr David Black:

Absolutely not.


Newshost:

But you are an expert on the subject?


Dr David Black:

Indeed.


Newshost:

The first question comes from Dylan Patterson, Friday Harbour, USA who asks: What is anaemia?


Dr David Black:

Anaemia is when people do not have the normal number of red blood cells circulating in the blood stream. Red blood cells carry the oxygen from the lungs and are pumped around to all the other tissues in the body. So when people become anaemic, for whatever reason, they don't have as much oxygen going round so they begin to feel tired, dizzy, washed out, palpitations and generally under the weather.


Newshost:

In itself, anaemia isn't always serious is it?


Dr David Black:

No.


Newshost:

My understanding is that it is an indication perhaps of other problems.


Dr David Black:

Indeed. Anaemia just means you don't have quite enough red blood cells. How serious it is depends on how low your haemoglobin level is when it is measured in the blood. Most people have mild anaemia when it is discovered, often just on routine blood tests. They can often be treated with tablets - perhaps iron tablets - iron deficiency anaemia being the commonest cause of anaemia in the population and certainly the commonest cause in old age.


Newshost:

What causes anaemia?


Dr David Black:

I am afraid the number of causes are absolutely vast. The commonest cause is iron deficiency. The commonest reason for that in a younger age group is young women with periods. In the older age group, it is usually due to a gradual loss of blood from somewhere in the gastro-intestinal tract. It can be very gradual - people don't notice anything at all and the symptoms of tiredness just gradually creep up on them. The worry is that they say it is just my age but actually they have got a very treatable cause. So it can be anywhere - it can be ulcers, it can be drugs that irritate the stomach lining and can cause very gradual loss of blood. It could be polyps in the large bowel - in about a quarter of older people with iron deficiency anaemia, investigations will show a cause like that including, rarely, a cancer of the bowel. So it is always worth investigating.


Newshost:

Obviously there was a lot of concern when people heard that the Queen Mother was suffering from anaemia but how common is it in women over the age of 65 years of age?


Dr David Black:

Figures of up to 10% are certainly quoted at any one time. People may have at least a degree of anaemia - so it is really a very common cause. It is less common to have such a severe anaemia that you need a blood transfusion.


Newshost:

John Hampson, Peterborough, UK asks: How dangerous is anaemia if it left untreated, especially in the elderly?


Dr David Black:

If people get progressively worse and it is not treated, they can obviously die - if you have no blood going round you obviously can't live. The greater risk in older people is that they have got, what we call less physiological reserve - they are less able to deal with stresses. So that a level of haemoglobin that you or me could deal with would be much harder for an older person to cope with. So it is important to find and treat the cause and to treat with iron tablets or, as in this case, a blood transfusion, to bring the level of haemoglobin back up to normal as soon as possible.


Newshost:

I have heard it described that, especially in an elderly person, if you have a complete blood transfusion like the Queen Mother is said to have undergone, that that can, in the short-term, give them quite a fillip.


Dr David Black:

I think people often feel, if they have been very anaemic, they will feel dramatically better when they have had a blood transfusion - it depends on how anaemic you were to start with.


Newshost:

Malcolm Saunders, Grand Cayman, asks: Could the anaemia be an indication of a more serious underlying condition?


Dr David Black:

As I think I have indicated already, iron deficiency, the commonest cause, can indicate in about 25% of people that there is a more serious problem of the gastro-intestinal tract. There are other causes of anaemia - people often have heard about pernicious anaemia - this is a deficiency of a vitamin called B12. Older trouble have trouble absorbing it from their food often because of ageing changes in the stomach and if that is untreated it can be very serious but that can be treated with regular injections.

Less commonly you can get leukaemias and types of leukaemias in the elderly which would present as anaemia. Then there is a whole group of people who are non-specifically well with chronic infections or other cancers or other chronic illnesses which can just generally suppress the bone marrow and cause anaemia as another symptom of their illness.


Newshost:

This will be the concern for the Queen Mother's doctors - they will be looking for evidence of any underlying problem. We have a question here from Madeline Smith, Lewes, UK who asks: What sort of tests will the Queen Mother have undergone in hospital over the last 24 hours?


Dr David Black:

I am sure the main test that they would have done would have been blood ones. Firstly to show the anaemia and secondly to measure levels of iron, B12 and folic - to look for whether there are deficiencies of these constituents because if there are then that gives clues to the tests that need to be done.

If she is iron deficient - and we don't know if she is - then normally you would investigate someone with tests of the gastro-intestinal tract and that would normally be a gastroscopy - which is a test when you swallow a small tube and you can examine the inside lining of the stomach and a similar sort of test on the large bowel as well. So those would be the conventional tests which one would start off with if a patient was iron deficient.


Newshost:

The difficulty with this case is that of course when you have a patient of such a great age then you also have concerns about any kind of invasive procedures whereas simple blood tests are quite straightforward, other tests might be much harder to carry out.


Dr David Black:

It is probably not harder to carry out but you have always got to be aware of the balance between not wanting to do harm and doing good. So if you are doing tests simply to make a diagnosis that would maybe be pointless. If you are doing tests because you can find something that is very easily treatable - for example, if you found that she had got a small ulcer in the stomach that had bled very slowly that would be easily treatable and curable with tablets so it is worth doing the test to find out if that is the case. Similarly, if you didn't find it out and you left it you could get worse complications.


Newshost:

Caroline Fraser, Bromley, Kent, UK asks: Could it be that medication that the Queen Mother is taking could possibly lead to the anaemia?


Dr David Black:

We don't know what medication she is on but the history we do know is that she has arthritis in the past and hip replacements and it is possible that she is on various sorts of aspirin and aspirin-like painkillers which are known to irritate the lining of the stomach and the bowel and are recognised as a cause of chronic anaemia. If that is the case she may have to stop or change those drugs in the future - they would certainly be a very simple cause for her problems.


Newshost:

Robert Crofter, Basingstoke, UK asks: The Queen Mother's doctors went for the blood transfusion but was that the only option in a case like this or is there a number of choices?


Dr David Black:

It depends how symptomatic people are. Again going back to the commonest cause of anaemia - iron deficiency - you have choices. You are going to give them iron tablets anyway whatever you do - but do they need a blood transfusion - and that is a balance that has to be decided - how symptomatic people are, how low the level of haemoglobin was. There are national guidelines as to about the level that people would normally use tablets rather than a blood transfusion.


Newshost:

Whenever you have a high profile case like this, a lot of people who have experienced anaemia in their family prompts questions about their own treatment. Mrs Mates, Newmarket, Suffolk, UK asks: My husband developed anaemia which was later found to have been caused by colon cancer. He waited more than three months for surgery. Would the immediate use of a blood transfusion in the case of mild anaemia be the usual practice?


Dr David Black:

It is very difficult to relate the blood transfusion with what obviously her concern is about - the wait for surgery. I think all of us are concerned about waits for surgery or anything else in the health service. The message I would certainly would want to give is that anaemia can signify serious trouble and that people should be investigated for it.


Newshost:

John Sorrell, London, UK asks: I am curious about the source of the blood used in the Queen Mother's blood transfusion. Does the Royal Family have their own blood stocks standing by for blood transfusions?


Dr David Black:

I believe that the heads of all states will have blood supply ready and available - where it comes from I have no idea.

See also:

01 Aug 01 | Medical notes
Anaemia
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