frontal
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Over the past 8 weeks, a 66 year old man with moderately severe AS has had worsening of her shortness of breath and exertional chest pains. Exam shows pallor and JV distention. Bilateral crackles are heard. A harsh, late-peaking systolic murmur is heard best at the cardiac base. Test of stool for occult blood is positive. Labs: Hb 7.4g%, MCV 70, TLC 5400/CU.MM, PLATELETS 580,000/CU.MM, ESR 33MM/H. BLOOD SMEAR: HYOCROMIC MICROCYTIC RBCS WITH MODERATE POIKILOCYTOSIS. What is the most likely diagnosis?
A. ANEMIA OF CHRONIC DISEASE
B. AUTOIMMUNE HEMOLYTIC ANEMIA
C. FOLATE DEFICIENCY ANEMIA
D. IRON DEFICIENCY ANEMIA
E. MICROANGIOPATHIC HEMOLYTIC ANEMIA
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| DrS
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D. IRON DEFICIENCY ANEMIA
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| phuluong2k
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D
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| mani
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D..
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Sincerity and hard work are the keys to success!
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| frontal
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Rrright answer . Now tell me what's with them occult blood positive stools ?
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| DrS
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occult blood positive stools means he is bleeding from the GI tract, which is the most probable cause for his iron deficiency anemia.
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| frontal
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That's true, but surely, in the question, no cause for an upper GI bleed is apparent.
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| DrS
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| | 11/27/05 - 08:45 AM
1 of 1 forum leaders found this post helpful
| #8 |
a positive stools for occult blood DOES NOT indicate UPPER GI BLEEDING. Bleeding anywhere in the GIT will cause a positive test, in fact thats why its used as a screening test for LARGE BOWEL cancers to detect small amounts of bleeding in lower GI malginancies.
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| frontal
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HELL YES. I don't know why I typed upper. That was as stupid as it gets.
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| DrS
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hey dont worry, it happens to everyone 
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| PKG
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why does the patient have thrombocytosis?
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| Dr Serguera
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D
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| aimhigh
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yea...I have the same question about the increased platelets...anyone can explain this please?
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| aimhigh
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by the way, HYOCROMIC MICROCYTIC RBCS + positive occult blood stool in an eldly man indicates sigmoidoscopy (colonoscopy better) for next step management, right?!
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| Dr Serguera
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Myeloproliferative disorders..?, may be essential trombocytopenia.
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| vrach
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A reactive thrombocytosis is often present in association with iron deficiency anemia..... don't know why. Essential Thrombocythemia could be a cause of the GI bleed, but it is just too rare a dis. and there would be abnormal looking platelets on the smear. Could packed RBC transfussion be the next best step in the management of this pt.? I mean you could get a colonoscopy, but he could die of an MI while you are doing one!
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