Question on blood disorder!!!

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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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Specializes in cardiac/critical care/ informatics.

Most likely a long term bleed peptic ulcer or such. iron levels will drop with a long term bleed. ( I had heavy periods for years my iron was only 4) I don't seriously the laceration on his forehead has anything to do with his dx. Good Luck

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Specializes in cardiac/critical care/ informatics.

ps your on the right track, good critical thinking.

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Do u know what haematological condition he is having? And by the way what is Ferritin for?

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Any time you are looking to come up with a diagnosis, any diagnosis, you must first look at the signs and symptoms that patient is having. A diagnosis is the decision or opinion you make after the process of examination or investigation of the facts. In the medical and nursing world that means after you do an assessment of the patient and an analysis of the assessment you then make your decision. This is the information you were given:

  • passing melena stool for the pass 3 months - melena is black, tarry feces due to the action of intestinal secretions of blood in the stool--in other words the patient has blood somewhere in his GI tract for some unknown reason
  • laceration on his forehead (but no other information given)
  • fainted - also known as syncope it is a temporary loss of consciousness for seconds or minutes because of impaired cerebral blood supply or cerebral hypoxia
  • pale - or pallor, is loss of skin color caused primarily by anemia
  • tired - or fatigue is a lack of energy or exhaustion along with an intense desire to rest or sleep and is often due to a lack of cellular energy; frequent causes are anemia, depression, heart failure and renal failure.
  • corners of his mouth cracked - dehydration?
  • sore throat - can be due to chronic fatigue syndrome or infection
  • Haemoglobin level is 8.1g/dl - normal for an adult male is 14-18g/dl - this man's level is very low! Conditions associated with low hemoglobin include: anemia, severe hemorrhage, hemolysis, hemoglobinopathies, cancer, nutritional deficiency, lymphoma, systemic lupus erythematosus, sarcoidosis, kidney disease, chronic hemorrhage, splenomegaly, sickle cell anemia and neoplasia (page 366, Mosby's Diagnostic and Laboratory Test Reference, 4th edition)
  • Iron & Ferritin level were low (but weren't specified) - low serum iron levels are associated with: insufficient dietary iron, chronic blood loss, inadequate absorption of iron, late stage of pregnancy, iron deficiency anemia, neoplasia, chronic gastrointestinal blood loss, chronic hematuria, chronic heavy physiologic or pathologic menstruation (page 505, Mosby's Diagnostic and Laboratory Test Reference, 4th edition). low serum ferritin levels are associated with: severe protein deficiency, iron deficiency anemia, and hemodialysis (page 397, Mosby's Diagnostic and Laboratory Test Reference, 4th edition)

The orders that were given were:

  • ferrous fumarate 200mgm OM (every morning) - used in iron deficiency anemia to replace iron stores needed for red blood cell development, energy and oxygen transport and utilization
  • 1U packed cells - given to restore oxygen carrying capacity
  • gastroscopy - direct examination of the upper GI tract for tumors, varices, mucosal inflammation, hiatal hernias, polyps, ulcers, and obstructions
  • colonoscopy - direct examination of the entire colon (large intestine) for benign or malignant neoplasms, polyps, mucosal inflammation, ulcers and sites of active hemorrhage

Now, having gone through the assessment information and analyzed it, what would you say this patient's haematological (pertaining to the blood or blood forming organs) condition is?

I would say that based upon the fact that the patient has had three months of melena he has some kind of GI bleeding going on and that blood loss anemia is what is going on. All the other symptoms are indications of the anemia which is the result of the blood loss. This patient probably has a malignant tumor or a gastric/duodenal ulcer, both of which cause bleeding and inflammation and will lead to all the other symptoms the patient is having if not treated.

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Sorry. And thanks for all ur suggestions. I think I've type wrongly. He complained of "sore tongue" not "sore throat".

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Specializes in med/surg, telemetry, IV therapy, mgmt.
Sorry. And thanks for all ur suggestions. I think I've type wrongly. He complained of "sore tongue" not "sore throat".

A sore tongue is not going to make a that big of a difference here! It is a symptom of his dehydration. This patient is having GI bleeding and loosing fluids because of it. You were asked to give a hematological diagnosis, not a metabolic diagnosis. Hematologically, this patient is having blood loss anemia. Metabolically he is dehydrated. However, you were not asking about his metabolic condition.

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I think I understand what you mean. The patient is probably having GI or intestinal problem which causes bleeding. Thus he's passing melana stool. This causes blood loss and loss of fluid & electrolytes, which made the patient faint and have cracked mouth. The doctor ordered ferrous fumarate is to replace the blood loss. Gastroscopy and colonoscopy is to investigate for any abnormalities which cause melana stool.

Thank you Daytonite, you've been a great help:nurse:

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