Lower gastrointestinal bleeding laboratory findings: Difference between revisions

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Revision as of 23:31, 11 December 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Laboratory Findings

The minimum essential blood work in diagnosing lower gastrointestinal bleeding includes a complete blood count, renal function and liver function tests, and coagulation studies. Although not diagnostic, a blood type and crossmatch should be done in patients who present with life-threatening bleeding.

Complete blood count

Complete blood count may show a low hemoglobin level or a drop from a previous baseline level.
In acute blood loss, the initial hemoglobin level may be normal but will fall with fluid resuscitation.
Other abnormalities, such as thrombocytopenia, may point to a variceal source of bleeding.
The presence of uremia or a history of aspirin or clopidogrel use should be noted, as both factors can significantly affect platelet function without causing thrombocytopenia. *A raised leukocyte count may point to an infectious or inflammatory cause.

Renal function tests

Abnormal values of renal function tests of may indicate underlying kidney disease, a condition associated with increased risk for gastrointestinal bleeding.
A disproportionately raised urea nitrogen level may suggest bleeding from an upper gastrointestinal source or hemoconcentration.
Intravenous contrast for angiograms must be administered with caution in patients with renal impairment to avoid the risk of contrast nephropathy.

Liver function tests

Persons with an underlying liver disease are at increased risk of gastrointestinal bleeding, and bleeding may be more difficult to control due to coagulopathy associated with liver dysfunction.
Abnormal liver function may suggest the presence of colorectal varices.

Coagulation studies

An elevated INR may indicate anticoagulation with warfarin or may be evidence of severe liver dysfunction.
A prolonged aPTT is seen in anticoagulation with heparin.

Blood type and cross match

Identifies blood groups A, B, AB, O and Rhesus (Rh) factor.
Essential in the management of hemodynamically unstable patients who may need a blood transfusion.

References

Template:WH Template:WS

@@ Line 4: / Line 4: @@
 ==Overview==
-An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
-OR
-Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
-OR
-[Test] is usually normal among patients with [disease name].
-OR
-Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
-OR
-There are no diagnostic laboratory findings associated with [disease name].
 ==Laboratory Findings==
+The minimum essential blood work in diagnosing lower gastrointestinal bleeding includes a complete blood count, renal function and liver function tests, and coagulation studies. Although not diagnostic, a blood type and crossmatch should be done in patients who present with life-threatening bleeding.
-*There are no diagnostic laboratory findings associated with [disease name].
+===Complete blood count===
-OR
+*Complete blood count may show a low hemoglobin level or a drop from a previous baseline level.
-*An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
+*In acute blood loss, the initial hemoglobin level may be normal but will fall with fluid resuscitation.
-*[Test] is usually normal among patients with [disease name].
+*Other abnormalities, such as thrombocytopenia, may point to a variceal source of bleeding.
-*Laboratory findings consistent with the diagnosis of [disease name] include:
+*The presence of uremia or a history of aspirin or clopidogrel use should be noted, as both factors can significantly affect platelet function without causing thrombocytopenia. *A raised leukocyte count may point to an infectious or inflammatory cause.
-**[Abnormal test 1]
+===Renal function tests===
-**[Abnormal test 2]
+*Abnormal values of renal function tests of may indicate underlying kidney disease, a condition associated with increased risk for gastrointestinal bleeding.
-**[Abnormal test 3]
+*A disproportionately raised urea nitrogen level may suggest bleeding from an upper gastrointestinal source or hemoconcentration.
+*Intravenous contrast for angiograms must be administered with caution in patients with renal impairment to avoid the risk of contrast nephropathy.
-*Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
+===Liver function tests===
+*Persons with an underlying liver disease are at increased risk of gastrointestinal bleeding, and bleeding may be more difficult to control due to coagulopathy associated with liver dysfunction.
+*Abnormal liver function may suggest the presence of colorectal varices.
+===Coagulation studies===
+*An elevated INR may indicate anticoagulation with warfarin or may be evidence of severe liver dysfunction.
+*A prolonged aPTT is seen in anticoagulation with heparin.
+===Blood type and cross match===
+*Identifies blood groups A, B, AB, O and Rhesus (Rh) factor.
+*Essential in the management of hemodynamically unstable patients who may need a blood transfusion.
 ==References==
 {{Reflist|2}}