Anemia ec Perdarahan

Saluran Cerna

Anemia
Anemia is present in adults if the hematocrit is < 41% (hemoglobin < 13.5
g/dL [135 g/L]) in males or < 36% (hemoglobin < 12 g/dL [120 g/L]) in
females. The most common cause of anemia is iron deficiency
A severely microcytic anemia (mean corpuscular volume [MCV] < 70 fL) is
due either to iron deficiency or thalassemia, while a severely macrocytic
anemia (MCV < 125 fL) is almost always due to either megaloblastic
anemia or to cold agglutinins in blood analyzed at room temperature.

Gastrointestinal Bleeding
Acute Upper Gastrointestinal Bleeding
Approximately half of patients are over 60 years of
age, and in this age group the mortality rate is even
higher. The most common presentation of upper
gastrointestinal bleeding is hematemesis or melena.
Hematemesis may be either bright red blood or
browncoffee grounds material. Melena develops
after as little as 50100 mL of blood loss in the upper
gastrointestinal
tract,
whereas
hematochezia
requires a loss of more than 1000 mL.

Etiologi
Peptic Ulcer
Disease

Portal
Hypertension

MalloryWeiss Tears

Vascular
Anomalies

Gastric
Neoplasms

Erosive
Gastritis

Erosive
Esophagitis

Others

Erosive Gastritis
Because this process is superficial, it is a relatively unusual
cause of severe gastrointestinal bleeding (< 5% of cases) and
more commonly results in chronic blood loss. Gastric mucosal
erosions are due to NSAIDs, alcohol, or severe medical or
surgical illness (stress-related mucosal disease).

Initial Evaluation & Treatment

Stabilization
Blood replacement
Initial Triage

Stabilization
A heart rate over 100 beats/min with a systolic blood pressure
over 100 mm Hg signifies moderate acute blood loss
Blood is sent for complete blood count, prothrombin time with
international normalized ratio (INR), serum creatinine, liver
enzymes, and blood typing and screening (in anticipation of
need for possible transfusion)

Blood Replacement
Sufficient packed red blood cells should be given to maintain a
hemoglobin of 79 g/dL, based on the patients hemodynamic
status, comorbidities (especially cardiovascular disease), and
presence of continued bleeding
In the absence of continued bleeding, the hemoglobin should
rise approximately 1 g/dL for each unit of transfused packed
red cells

Initial Triage
Clinical predictors of increased risk of rebleeding and death include age > 60

years, comorbid illnesses, systolic blood pressure < 100 mm Hg, pulse > 100
beats/min, and bright red blood in the nasogastric aspirate or on rectal
examination
High riskPatients with active bleeding manifested by hematemesis or bright red

blood on nasogastric aspirate, shock, persistent hemodynamic derangement

despite fluid resuscitation, serious comorbid medical illness, or evidence of
advanced liver disease require admission to an intensive care unit (ICU).

 Low to moderate riskAll other patients are admitted to a

step-down unit or medical ward after appropriate stabilization
for further evaluation and treatment. Patients without
evidence of active bleeding undergo nonemergent endoscopy
usually within 24 hours

Kesimpulan
Pada pasien ini di diagnosis anemia ec gastrointestinal bleeding. Pada

pasien di deiagnosis anemia karena hematokrit < 41% (22,7%) dan

hemoglobin < 12g/dL (7.5 g/dl). Kemungkinan pada pasien penyebab dari
anemia adalah karena gastrointestinal bleeding.
Pada pasien didapatkan adanya muntah kehitaman dan BAB kehitmana

yang merupakan tanda dari acute upper GI bleeding dan penyebabnya

adalah karena gastritis erosive karena pasien mempunyai riwayat
meminum obat obatan anti nyeri.

 Treatment pada pasien ini berdasarkan 3 prinsip initial

treatment
1. Stabilization
2. Blood replacement
3. Initial triage