Blood clots in urine, fever, no bleeding during gastroscopy, an old man in his 90s relies on “1 method” to find out the cause
The contrast agent is radioactive and has the risk of nephrotoxicity. Drink plenty of water to excrete it
Grandpa Chen, who is in his 90s, had a fever for unknown reasons and a blood clot in the catheter placed. He was sent to the hospital by his family for emergency treatment. The emergency department performed a blood test for Grandpa Chen. The result showed that the hemoglobin (Hgb) was only 5.2 gm/dL. (The reference value for adult males is 13.0 to 18.0 gm/dL; for females, it is 11.0 to 16.0 gm/dL), indicating that the anemia is very severe and gastrointestinal bleeding is suspected.
Hung Bo-bin, director of the Department of Integrative Medicine at Taipei Tzu Chi Hospital, said that although the patient had multiple gastric ulcers but no bleeding, he found bright spots (ie, bleeding) in the left upper abdomen through a “red blood cell hemorrhage scan”. Gastric ulcer bleeding”, following treatment with high-dose hydrogen ion blocker, the tracked hemoglobin value was stable, and the patient was discharged smoothly.
Multiple symptoms suggest the possibility of gastrointestinal bleeding
Hong Bobin said: “Clinical follow-up found that the patient has blood clots in urination, the hemoglobin continues to drop, and the black stool is resolved, so there is the possibility of gastrointestinal bleeding.” The gastrointestinal tract is a lumen structure, which is the most prone to massive bleeding , Medically, in order to prevent the patient from continuous bleeding causing hypovolemic shock, blood transfusion will be given and a gastroscopy will be arranged. However, Grandpa Chen’s hemoglobin only rose to 9.6 gm/dL following the emergency blood transfusion of 9 bags, which showed that he was still bleeding. Although there were 4 ulcers with pink scar tissue in gastroscopy, in order to rule out the ulcers at the time of examination, there were no signs of bleeding. , so the medical team further arranged for a red blood cell hemorrhage scan.
Red blood cell hemorrhage scans are generally used when routine gastroscopy cannot determine the location of bleeding in the gastrointestinal tract, to confirm whether the bleeding is in an obscure and rare location. The inspection procedure must first go to the Department of Nuclear Medicine for the injection and inspection of radioactive contrast agent. The nuclear medicine physician confirms that the contrast agent is injected into the vein correctly, and completes the process of isotope labeling of red blood cells. Then the patient is asked to lie on the examination bed with the photosensitive film. After a period of time , the results of scattered radiation exposure can be directly confirmed.
The contrast agent is radioactive and has the risk of nephrotoxicity, so drink plenty of water to excrete it
Then, by imaging the bright spots, the examination results will directly show whether there is bleeding: if there is no bleeding, the red blood cells are flowing in the body, and the imaging will be evenly distributed; on the contrary, if there is bleeding, the bleeding blood will accumulate locally, and the scan results will form a spot. Highlights. Hong Bobin explained: “The radiation dose of hemorrhage scans is very low, but because the contrast agent itself is radioactive, there is a risk of kidney toxicity. Therefore, following performing the examination, the patient must take more water to promote excretion. If there is kidney disease, the first pregnancy Pregnant women and the elderly in the first stage must inform the doctor of their own situation, and let the doctor choose another examination and treatment.”
In addition to comorbidities and infections in the elderly, some drugs such as antiplatelet preparations and non-steroidal analgesics may also cause gastrointestinal bleeding, but now with advanced medical technology, in addition to cooperating with gastrointestinal endoscopy, it can also be applied” Red blood cell hemorrhage scan” for rapid diagnosis and treatment through blood transfusion. Director Hong Bobin reminded that common bleeding symptoms include: bruising or bleeding spots on the skin, easy nosebleeds, coughing up bloody sputum, resolving hematuria, and releasing bloody stools or black stools, etc. , should be alert and seek medical attention as soon as possible.
Further reading:
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