Upper gastrointestinal bleeding laboratory findings: Difference between revisions
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==Initial Laboratory Studies== | ==Initial Laboratory Studies== | ||
*Common laboratory findings include [[anemia]], [[coagulopathy]], and an elevated [[BUN-to-creatinine ratio]]. | *Common laboratory findings include [[anemia]], [[coagulopathy]], and an elevated [[BUN-to-creatinine ratio]].<ref name="pmid26034359">{{cite journal |vauthors=Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N |title=Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding |journal=World J. Gastroenterol. |volume=21 |issue=20 |pages=6246–51 |year=2015 |pmid=26034359 |pmc=4445101 |doi=10.3748/wjg.v21.i20.6246 |url=}}</ref><ref name="pmid26034359">{{cite journal |vauthors=Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N |title=Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding |journal=World J. Gastroenterol. |volume=21 |issue=20 |pages=6246–51 |year=2015 |pmid=26034359 |pmc=4445101 |doi=10.3748/wjg.v21.i20.6246 |url=}}</ref> | ||
*The hematocrit level is used to identify the degree of blood loss and suggests the acuity or chronicity of blood loss.<ref name="pmid17983811">{{cite journal |vauthors=Raju GS, Gerson L, Das A, Lewis B |title=American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding |journal=Gastroenterology |volume=133 |issue=5 |pages=1694–6 |year=2007 |pmid=17983811 |doi=10.1053/j.gastro.2007.06.008 |url=}}</ref><ref name="pmid23547576">{{cite journal |vauthors=Bull-Henry K, Al-Kawas FH |title=Evaluation of occult gastrointestinal bleeding |journal=Am Fam Physician |volume=87 |issue=6 |pages=430–6 |year=2013 |pmid=23547576 |doi= |url=}}</ref> | *The hematocrit level is used to identify the degree of blood loss and suggests the acuity or chronicity of blood loss.<ref name="pmid17983811">{{cite journal |vauthors=Raju GS, Gerson L, Das A, Lewis B |title=American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding |journal=Gastroenterology |volume=133 |issue=5 |pages=1694–6 |year=2007 |pmid=17983811 |doi=10.1053/j.gastro.2007.06.008 |url=}}</ref><ref name="pmid23547576">{{cite journal |vauthors=Bull-Henry K, Al-Kawas FH |title=Evaluation of occult gastrointestinal bleeding |journal=Am Fam Physician |volume=87 |issue=6 |pages=430–6 |year=2013 |pmid=23547576 |doi= |url=}}</ref> | ||
*Serial complete blood count (CBC) tests are important for monitoring the presence of ongoing blood loss. | *Serial complete blood count (CBC) tests are important for monitoring the presence of ongoing blood loss. | ||
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*Qualitatively, on peripheral blood smear prepared with Wright-Giemsa stain, normal erythrocytes should be smaller than the nucleus of a normal lymphocyte, and the central clear area should not be overly prominent. | *Qualitatively, on peripheral blood smear prepared with Wright-Giemsa stain, normal erythrocytes should be smaller than the nucleus of a normal lymphocyte, and the central clear area should not be overly prominent. | ||
*In iron-deficiency anemia associated with chronic blood loss, erythrocytes are smaller (microcytic) and appear lighter (hypochromic) than normal cells. | *In iron-deficiency anemia associated with chronic blood loss, erythrocytes are smaller (microcytic) and appear lighter (hypochromic) than normal cells. | ||
*Mild to moderate thrombocytopenia (>30 × 103/µL) does not usually result in spontaneous bleeding, although patients with a pre-existing lesion may bleed in the presence of even mild thrombocytopenia. | *Mild to moderate thrombocytopenia (>30 × 103/µL) does not usually result in spontaneous bleeding, although patients with a pre-existing lesion may bleed in the presence of even mild thrombocytopenia.<ref name="pmid27588176">{{cite journal |vauthors=Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N |title=Low hemoglobin levels are associated with upper gastrointestinal bleeding |journal=Biomed Rep |volume=5 |issue=3 |pages=349–352 |year=2016 |pmid=27588176 |pmc=4998006 |doi=10.3892/br.2016.727 |url=}}</ref> | ||
*Platelet count may rise in response to significant gastrointestinal bleeding and may fall with multiple blood transfusions. | *Platelet count may rise in response to significant gastrointestinal bleeding and may fall with multiple blood transfusions. | ||
*Low ferritin level is the most specific test for iron-deficiency anemia. This finding together with a low iron and high TIBC levels are helpful in diagnosing iron-deficiency anemia, a common complication of ongoing or significant UGIB. | *Low ferritin level is the most specific test for iron-deficiency anemia. This finding together with a low iron and high TIBC levels are helpful in diagnosing iron-deficiency anemia, a common complication of ongoing or significant UGIB. | ||
*BUN level may be elevated out of proportion to any increase in the creatinine level in patients with UGIB, secondary to breakdown of blood proteins to urea by intestinal bacteria. | *BUN level may be elevated out of proportion to any increase in the creatinine level in patients with UGIB, secondary to breakdown of blood proteins to urea by intestinal bacteria.<ref name="pmid22534226">{{cite journal |vauthors=Wilkins T, Khan N, Nabh A, Schade RR |title=Diagnosis and management of upper gastrointestinal bleeding |journal=Am Fam Physician |volume=85 |issue=5 |pages=469–76 |year=2012 |pmid=22534226 |doi= |url=}}</ref> | ||
*In patients with esophageal varices, acquired coagulopathies are common due to cirrhosis. | *In patients with esophageal varices, acquired coagulopathies are common due to cirrhosis. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
In patients with acute Upper GI bleeding who are unstable rapid assessment and resuscitation should be initiated even before diagnostic evaluation. Once hemodynamic stability is achieved, a proper clinical history, physical examination, and initial laboratory findings are crucial not only in determining the likely sources of bleeding but also in directing the appropriate intervention. In acute GI bleeding, initial hematocrit level measured will not accurately reflect the amount of blood loss. Laboratory findings of chronic upper GI bleeding include anemia, coagulopathy, and an elevated BUN-to-creatinine ratio.
Initial Laboratory Studies
- Common laboratory findings include anemia, coagulopathy, and an elevated BUN-to-creatinine ratio.[1][1]
- The hematocrit level is used to identify the degree of blood loss and suggests the acuity or chronicity of blood loss.[2][3]
- Serial complete blood count (CBC) tests are important for monitoring the presence of ongoing blood loss.
- Initial CBC may not fully reflect the actual degree of acute blood loss.
- Qualitatively, on peripheral blood smear prepared with Wright-Giemsa stain, normal erythrocytes should be smaller than the nucleus of a normal lymphocyte, and the central clear area should not be overly prominent.
- In iron-deficiency anemia associated with chronic blood loss, erythrocytes are smaller (microcytic) and appear lighter (hypochromic) than normal cells.
- Mild to moderate thrombocytopenia (>30 × 103/µL) does not usually result in spontaneous bleeding, although patients with a pre-existing lesion may bleed in the presence of even mild thrombocytopenia.[4]
- Platelet count may rise in response to significant gastrointestinal bleeding and may fall with multiple blood transfusions.
- Low ferritin level is the most specific test for iron-deficiency anemia. This finding together with a low iron and high TIBC levels are helpful in diagnosing iron-deficiency anemia, a common complication of ongoing or significant UGIB.
- BUN level may be elevated out of proportion to any increase in the creatinine level in patients with UGIB, secondary to breakdown of blood proteins to urea by intestinal bacteria.[5]
- In patients with esophageal varices, acquired coagulopathies are common due to cirrhosis.
References
- ↑ 1.0 1.1 Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N (2015). "Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding". World J. Gastroenterol. 21 (20): 6246–51. doi:10.3748/wjg.v21.i20.6246. PMC 4445101. PMID 26034359.
- ↑ Raju GS, Gerson L, Das A, Lewis B (2007). "American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding". Gastroenterology. 133 (5): 1694–6. doi:10.1053/j.gastro.2007.06.008. PMID 17983811.
- ↑ Bull-Henry K, Al-Kawas FH (2013). "Evaluation of occult gastrointestinal bleeding". Am Fam Physician. 87 (6): 430–6. PMID 23547576.
- ↑ Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N (2016). "Low hemoglobin levels are associated with upper gastrointestinal bleeding". Biomed Rep. 5 (3): 349–352. doi:10.3892/br.2016.727. PMC 4998006. PMID 27588176.
- ↑ Wilkins T, Khan N, Nabh A, Schade RR (2012). "Diagnosis and management of upper gastrointestinal bleeding". Am Fam Physician. 85 (5): 469–76. PMID 22534226.