Gastrointestinal Bleeding and Anemia: Causes and Symptoms

Posted on Jan 10, 2025 in Nursing

Gastrointestinal Bleeding: Manifestations

Hematemesis

Expulsion of blood from the upper digestive tract through the mouth, preceded by vomiting. Blood may appear red or like coffee grounds.

Melena

Expulsion of blackish, sticky, dough-like blood from the upper digestive tract through the anus.

Hematochezia or Rectal Bleeding

Red blood expelled from the anus, originating from the lower GI tract. The first is often accompanied by feces.

Fecal Occult Blood

Manifested by iron deficiency anemia.

Acute upper gastrointestinal bleeding (UGIB) can be discreet, moderate, or massive.

1. Upper Gastrointestinal Bleeding (UGIB)

Injuries located above the angle of Treitz (esophagus, stomach, or duodenum). Characterized by vomiting red or dark red blood, preceded by nausea and retching, and followed by the elimination of pasty, black, shiny, tar-like stools.

2. Lower GI Bleeding (LGIB)

Originates below the angle of Treitz (jejunum, ileum, or colon). It is characterized by the elimination of bright red or dark red blood.

Causes of UGIB
  • Rupture of esophageal varices
  • Gastric and duodenal ulcers
  • Gastritis and duodenitis
  • Erosive hemorrhagic esophagitis
  • Ulcer of the second portion of the duodenum
  • Cancer of the esophagus and stomach
  • Hematological causes
Causes of LGIB
  • Bleeding
  • Erosion
  • Diverticulitis
  • Vascular dysplasia
  • Colorectal cancer
  • Non-specific ulcerative colitis
  • Granulomatous colitis (Crohn’s disease)
  • Ischemic colitis
  • Mesenteric vessel thrombosis
  • Complicated typhoid fever

Always ask the patient about alcohol ingestion, aspirin, NSAIDs, and corticosteroid use, which may be the origin of hemorrhagic erosive gastritis or gastric ulcer. Abdominal pain, weight loss, fatigue, and anorexia may indicate a malignancy of the digestive tract.

Implications of GI Bleeding
  • If heavy, it can trigger hypovolemic shock.
  • Post-hemorrhagic anemia
  • Increased blood urea
  • If the patient has liver failure or portal hypertension, this increase in urea can trigger hepatic encephalopathy.

Anemia

A pathological condition characterized by the reduced ability of hemoglobin (Hb) carried by the circulating red cells to provide oxygen to the tissues. Hb is less than 13 g/100 mL in men and less than 12 g/100 mL in women.

Symptoms and Signs

Skin and mucosal pallor, fatigue, adynamia, tachycardia and palpitations, dyspnea, headache, dizziness or vertigo, cloudy vision, decreased attention span, and early fatigue and muscle pain.

Characterization

  1. Morphological characteristics of red blood cell smear
  2. Reticulocyte count
  3. State of the other series (leukocytes and platelets)
  4. Data from the myelogram
  5. Data provided by bone marrow biopsy
  6. Alterations of red blood cells (RBC)
  • Size: anisocytosis, macrocytosis, microcytosis, megalocytosis
  • Form: poikilocytosis, ovalocytosis, elliptocytosis, spherocytosis, schizocytosis
  • Coloration: hypochromia, hyperchromia
  • Nuclear Remains: Howell-Jolly bodies, basophilic stippling, and Cabot ring

Etiopathogenic Classification

Central

1. For anhematopoiesis (without production of RBCs)

These are normocytic, normochromic, and hypo- or aregenerative anemias. The diagnosis is accurate.

  • Bone marrow biopsy
  • Bone marrow aplasia. It affects the white series and platelets.
  • Myelofibrosis
  • Invasion of the marrow by abnormal or foreign cells to the bone.

2. For dyshematopoiesis (difficult, functional hematopoiesis)

  • Deficiency of maturation factors
  • Refractory anemia
  • Anemia that accompanies cancer, cirrhosis, or chronic kidney disease

Peripheral

1. For premature destruction of RBCs: Hemolytic anemia

Reduced erythrocyte half-life of 120 days. They are microcytic and hyperregenerative. They are accompanied by increasing jaundice and splenomegaly of indirect bilirubin. They present a positive Coombs test and myelogram with marked erythroblastic hyperplasia.

  • Corpuscular
  • Extracorpuscular
  • Paroxysmal nocturnal hemoglobinuria

2. Blood loss (hemorrhage)

  • Acute: circulatory failure
  • Chronic: Small but permanent bleeding volume and the most frequent anemia (iron deficiency).

The most common causes of chronic blood loss are gynecologic and digestive, and less commonly, respiratory. These anemias are microcytic, hypochromic, and hyporegenerative, which is an index of red cell size uniformity, indicating anisocytosis.