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HOW TO EVALUATE THE SERIOUSNESS OF LOSS OF BLOOD, IN A PATIENT PRESENTING WITH HAEMATEMESIS

OP Kapoor

Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

Haematemesis is an extremely common symptom and a general practitioner will see dozens of patients every month following iatrogenic gastritis or alcoholic gastritis or Mallory Weiss syndrome in addition to some important chronic conditions like cirrhosis of the liver and peptic ulcer.

Most of the patients get so upset and nervous that they go on impressing the doctor, that they have lost a lot of blood at home in the vomit. How can one identify the patients who will need blood transfusion?

Though clinically, presence of pallor, restlessness, tachycardia and fall of blood pressure will help in the diagnosis, there are only two simple blood tests which can diagnose a severe upper GI bleed. These are (1) the presence of low haemoglobin and (2) a raised blood urea level with normal creatinine.

Finally it is worth remembering that the blood urea rises by the time the patient has lost 1 litre of blood, while the haemoglobin falls only after 2 litres of blood is lost (although this does not apply to PCV).



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