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Discussion

I have a Question

The patient has been passing melena stool for the pass 3 months.He has laceration on his forehead, fainted, looking pale and tired and the corners of his mouth cracked. He also complained of sore throat. Haemoglobin level is 8.1g/dl. Iron & Ferritin level were low. Doctor has ordered ferrous fumarate 200mgm OM, 1U packed cells to be transfused.The patient also need to go for gastroscopy & colonoscopy.

I need to identify the haematological condition he is having.

Am I right?:

He is either having nutritional anemia or iron deficiency anemia.

Excessive iron loss is either due to bleeding because of the laceration,

or because he may have occult blood loss from slowly bleeding peptic ulcer, GI inflammation, hemorrhoids & cancer, that's why doctor has ordered him to go for gastroscopy and colonscopy.

I don't understand what is ferritin for.

Ferrous fumarate is to replace iron loss.

1unit packed cells is to replace the blood loss.

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The ferritin is serum iron. Iron on the periodic table is Fe, remember? The ferrous fumarate will replace the serum iron to help with the anemia.

I wouldn't say the blood loss is from the laceration but that the laceration came from the fainting.

I'd say he's got a GI bleed due to the melena. The colonoscopy will r/o some sort of intestinal ulcer. The gastroscopy will r/o a bleeding peptic ulcer. The packed cells will help bring up the H/H quick as the iron replacement will take days if not weeks to show a significant increase in H/H.

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