Extreme Anemia (Hemoglobin 1.8 G/Dl) Secondary to Colon Cancer

Abstract

We present the case of a 34-year-old man who presented to the emergency department with complaints of generalized fatigue and palpitations, with a heart rate of approximately 100 beats per minute and an orthostatic blood pressure of 80/30 mm Hg upon standing. A hemoglobin of 1.8 g/dL was discovered. A positive fecal occult blood test led to the diagnosis of colon cancer. Once the cancer was resected, the patient's anemia resolved. E mergency department management of lower gastrointestinal bleeding, anemia, fatigue, and orthostasis are common ( 1-5 ). We report the lowest hemoglobin of which we are aware, at 1.8 g/dL, in a patient with lower gastrointestinal bleeding. CASE REPORTA 34-year-old previously healthy black man presented to the emergency department with a complaint of generalized fatigue and palpitations that had progressively increased over the last 6 months. Th e patient's heart rate was 100 to 105 beats/minute, and his blood pressure was 110/74 mm Hg when supine but 80/30 mm Hg upon standing. He was found to have marked conjunctival pallor with moist mucous membranes. He had generalized abdominal tenderness and a briskly positive fecal occult blood test absent of melena or overt blood. Electrocardiogram analysis showed Q waves in V1 to V3 with inverted T waves in V4 and lead III.Th e patient had had anemia as a child. He had no history of sickle cell or other hematopoietic disorders. He denied melenic or bloody stools. He indicated that he had been intermittently homeless over the prior 6 months. He denied a history of hepatitis, intravenous drug use, prosthetic valves, or hemoptysis.Initial laboratory evaluation was complicated by standard laboratory protocols rejecting the patient's complete blood count due to machine error, citing a "dilute" specimen. A call by the emergency physician requesting the release of the results after two rejected attempts showed on the third specimen severe anemia with a hemoglobin of 1.8 g/dL (Tables 1 and 2) .He was transfused with a total of 5 units of blood over 2 days, reaching a hemoglobin level of 7.6 g/dL, and provided Extreme anemia (hemoglobin 1.8 g/dL) secondary to colon cancer Rob E. Schmitt, MD, and Clifford J. Buckley II, MD, MBA with intravenous and oral iron and cholecalciferol supplementation. He underwent esophagogastroduodenoscopy as well as colonoscopy with biopsies showing extensive carcinoma of the colon. Th is was followed by a right hemi-and transverse colectomy with an ileostomy placement. Ultimately, the surgical specimen revealed a 13 × 11 × 4 cm 100% encircling high-grade, poorly diff erentiated adenocarcinoma. Th e patient, now 36 years old, had complete resolution of his anemia, with the most recent hemoglobin level being 14.0 g/dL just under 2 years after his colectomy. Proc (Bayl Univ Med

Extreme Anemia (Hemoglobin 1.8 g/dL) Secondary to Abnormal Uterine Bleeding

“…Severe anemia at a level < 4 g/dL is uncommonly seen in the hospital setting. Only two other cases have been reported on an ambulatory patient with a hemoglobin value of 1.8 g/dL, due to lower gastrointestinal bleeding and chronic urinary bleeding [ 7 , 8 ]. This case adds to other case reports of patient survival with a hemoglobin level of <2 g/dL [ 7 , 9 , 10 ].…”

Physician autonomy and patient rights: lessons from an enforced blood transfusion and the role of patient blood management

“…To this end, the expert witnesses for the plaintiff argued that haemoglobin results 'cannot constitute the sole parameter to be considered in the decision to carry out a transfusion, nor can it become an irrational element of psychological terror in clinical decision-making'. In addition, case reports of patients, from the international scientific literature, with particularly low haemoglobin values but displaying adequate compensation were presented [3,4]. The Court determined that the patient was not in a life-threatening emergency state; however, even if the patient's anaemia had deteriorated to engender the presumption of imminent death only avertable with transfusion, it would still not have been possible to deem exculpatory necessity applicable in pursuance to Art.…”

“…To this end, the expert witnesses for the plaintiff argued that haemoglobin results ‘cannot constitute the sole parameter to be considered in the decision to carry out a transfusion, nor can it become an irrational element of psychological terror in clinical decision‐making’. In addition, case reports of patients, from the international scientific literature, with particularly low haemoglobin values but displaying adequate compensation were presented [ 3 , 4 ].…”

Retracted: Extreme Anemia (Hemoglobin 1.8 g/dL) Secondary to Abnormal Uterine Bleeding

“…E. Schmitt and C. J. Buckley II, “Extreme Anemia (Hemoglobin 1.8 G/Dl) Secondary to Colon Cancer,” Baylor University Medical Center Proceedings, 29:4, 393-394, 2016. [2]…”