[khanar]

A 43 year old man was discovered to have a hemoglobin concentration of 10g/dl and 30% hematocrit on a routine preoperative visit.
What is the best next step in management?

A- Complete blood count and peripheral smear
B- Sigmoidoscopy and barium enema
C- Total colonoscopy
D- Iron, Ferritin, and TIBC
E- Folate and B12 levels

 

[FSUSTC]

I think its A . CBC and smear ......
As MCV is not given so it may be either macrocytic or microcytic .... and CBC includes MCV ... and smear may show hyperchromic or hypochromic ....
Choice D and E ... can be done once its diagnosed with MCV either its micro or macrocytic ..
Choice C and B ... as patient is under 50 yrs ... so its not required

 

[khanar]

I think its A . CBC and smear ......
As MCV is not given so it may be either macrocytic or microcytic .... and CBC includes MCV ... and smear may show hyperchromic or hypochromic ....
Choice D and E ... can be done once its diagnosed with MCV either its micro or macrocytic ..
Choice C and B ... as patient is under 50 yrs ... so its not required

So are you saying that if the patient was over 50 then we would have picked GI endoscopy!

 

[FSUSTC]

If there is anemia + fecal occult blood + 50 yrs ... even there is no fecal occult blood .. pt above 50 yrs should do colonoscopy routinely every 10 yrs ......

 

[khanar]

Disagree with FSUSTC

I think this question is reminding us of the basics of clinical practice. Even if the patient was above 50 and even if he has occult blood or even family history I'd still pick the CBC option.

It's a simple quick cheap test that can give good info. So for example if you find macrocytic anemia you definitely not going to do colonoscopy.

 

[matz]

accidental anamia

So are you saying that if the patient was over 50 then we would have picked GI endoscopy!

Hi , colonoscopy might be the best, I think in males at any age an iron deficiency anamia equals to canser detecting work up, while the first step is to check out GI for blood wasting.

 

[khanar]

Do CBC First

Hi , colonoscopy might be the best, I think in males at any age an iron deficiency anamia equals to canser detecting work up, while the first step is to check out GI for blood wasting.

I agree with Jayant here.
You have to do CBC first before you know it's Iron Deficiency anemia! The question did not say Iron deficiency anemia it just says it's anemia.

 

[FSUSTC]

Yes lots of thinks really depends on ques and how they ask ques ..... Lets c i might get a ques like that very soon ......
But its true ... in this ques they didnt say its microcytic ...
And for any anemia ... CBC and smear is the best initial test ....

 

[FSUSTC]

jayant and mary

In ques he said hb 10 and hct 30 ... These are included in CBC ... If u dont do CBC u cant know those 2 reading ... So why should we do cbc in this pt again , and why shouldnt we choose with 50 yrs and if in ques option has colonoscopy over cbc .........

 

[khanar]

In ques he said hb 10 and hct 30 ... These are included in CBC ... If u dont do CBC u cant know those 2 reading ... So why should we do cbc in this pt again , and why shouldnt we choose with 50 yrs and if in ques option has colonoscopy over cbc .........

You are absolutely right the question is mentioning Incomplete Blood Count

 

[mosallam]

do cbc

1 st line of management is to do cbc the cheapest , non invasive and simplest and guide you what way u will take

 

[khanar]

check the type of anemia first

In a similar question in Qbank;
Patient with positive occult blood in stool and no other findings, what is the next step?
they said check hematocrit!
in the explanation they said that you have to see what kind of anemia it is before you go to colonoscopy :indifferent: