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Author8 Posts
  #1

A 70 year old man was admitted with pallor, light-headedness and loss of energy. On the day prior to admission he had reported loose dark stools. Examination revealed a pulse of 90 per minute and a blood pressure of 110/70 mmHg.

Investigations revealed:
Haemoglobin 7.2 g/dL (14-18)
MCV 72 fL. (78-96)
White cell count 11.3 x 109/L (4-11)
Platelet count 480 x 109/L (150-400)

What is the most appropriate next step in his management?

1) Barium meal

2) Blood transfusion

3) Endoscopy

4) Parenteral iron infusion

5) Proton pump inhibitor therapy



  #2

i wud chose endoscopy... old man with a bleeding somewhere in the GIT/ anemia.. do a endscopy 1st to r/o colon Ca.. however i wud want to rehydrate him before i do the procedure ..but there is no option like that.. blood transfusion, i am not sure we want to transfuse him with blood.... usmle doesnt like blood transfuion too muchsmiling face

can anyone tell me what wudb the cut off limit of Hb for giving a blood transfusion?

thnx


  #3

blood transfusion ....then endoscopy.
as i remember in iron def anemia if Hg is < 8 g/dl >>>> do blood transfusion.

  #4

Start with [2) Blood transfusion], continue with [3) Endoscopy]

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  #5

next best step
soo endoscopy
he is not in failure soo bloood transfusion can wait

  #6

I think so.
Blood transfus. only for severe hemorr, his blood pressure is normal 110/70
Sorry, I don't have the ans.

  #7

IV and to Endoscopy... and beyond...he is not hemodinamicaly unstable. Transfusion can wait. If you give blood he ooze it out. You need to fix the problem in intestine. Besides, the blood will take several hours to crossmatch. Endoscopy first!

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"Life not lived for others, is not worth living" Uncle Einstein
"A life is not important, except in the impact it has on other lives" -Jackie Robinson

  #8

He has dark stool >> It's probably an upper GI bleeding,..

The next step is Endoscopy


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I will not say I failed 1000 times.. I will say that I discovered there are 1000 ways that can cause failure ..









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