Acute Blood Loss Anemia

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Acute Blood Loss Anemia

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Acute blood loss anemia 2/2 to UGI vs LGI bleed
-Likely Xxxx.
-DDx includes (UGI): Esophageal varices, Mallory-Weiss tear, Dieulafoy’s lesion, PUD, esophagitis, neoplasm, aortoenteric fistula (if hx of AAA repair).
-DDx includes (LGI): Diverticulosis, angiodysplasia, AVM, neoplasm, IBD, infectious colitis, anorectal disease (hemorrhoids, fissures).
-Rectal exam performed. Guaiac stool obtained.
-Holding anticoagulation, NSAIDs and antiplatelets.
-Obtain CBC, CMP, Coag Studies: evaluated H/H, Plts, PT, INR, AST, ALT, Albumin, BUN, and Cr.
-H/H q6H
–Type and screen/crossmatch
-Closely monitor ABCs, clinical status, vital signs, cardiac rhythm, UOP, NG output (if NGT in place)
-Orthostatic vital signs STAT and then Q4hrs. 
-Establish two large-bore IV lines (16 gauge or larger)
-Give IVF bolus before giving PRBC.  Also maintenance fluids.
-NPO
-Supplement Oxygen to keep saturation >92%
-GI consulted for emergent bleed for possible EGD +/- colonoscopy
-Start Protonix drip; Pantoprazole 80mg in NS 100ml OR Pantoprazole 40 mg IV bolus twice daily
-Will start Octreotide and Ceftriaxone for history of variceal bleed/cirrhosis.