Upper gastrointestinal bleeding laboratory findings

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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.

Laboratory Findings

• Laboratory findings include anemia, coagulopathy, and an elevated BUN-to-creatinine ratio.
• Determining whether blood is in gastric contents, either vomited or aspirated specimens, is surprisingly difficult. Slide tests are based on orthotolidine (Hematest reagent tablets and Bili-Labstix) or guaiac (Hemoccult and Gastroccult). Rosenthal found orthotolidine-based tests more sensitive than specific; the Hemoccult test's sensitivity reduced by the acidic environment; and the Gastroccult test be the most accurate. Cuellar found the following results:

Determining whether blood is in the gastric aspirate

Finding	Sensitivity	Specificity	Positive predictive value (prevalence of 39%)	Negative predictive value (prevalence of 39%)
Gastroccult	95%	82%	77%	96%
Physician assessment	79%	55%	53%	20%

Holman used simulated gastric specimens and found the Hemoccult test to have significant problems with non-specificy and false-positive results, whereas the Gastroccult test was very accurate. Holman found that by 120 seconds after the developer was applied, the Hemoccult test was positive on all control samples.