A Woman With DVT After a Flight, Anemia, and Bowel Changes

Jun H. Lee, MD; Marc D. Basson, MD, PhD


June 29, 2021

Physical Examination and Workup

Upon examination, the patient is a petite woman who appears well-nourished and hydrated. Her heart rate is 71 beats/min, her blood pressure is 131/72 mm Hg, her respiratory rate is 15 breaths/min, and her temperature is 99.0°F (37.2°C). Her conjunctivae are pink, and her extremities are warm and well perfused. No skin lesions or lymphadenopathy are present. No skin changes or lumps are palpable in either breast. Heart sounds are normal, and breath sounds are clear bilaterally.

Her abdomen is nondistended and soft to palpation with mild generalized tenderness, without guarding or peritoneal signs or palpable masses. Bowel sounds are normal. Neither obvious blood nor mucus nor a mass is apparent during rectal examination. No perianal skin tags, fissures, fistulae, or abscesses are found.

Distal pulses are present throughout.

The laboratory test results are as follows:

  • Hemoglobin level: 8 g/dL (reference range, 12-15.5 g/dL)

  • Mean corpuscular volume: 84 fL (reference range, 80-100 fL)

  • Hematocrit level: 25% (reference range, 36% to 48%)

  • Platelet count: 310,000/mcL (reference range, 150,000-400,000/mcL)

  • White blood cell count: 10,700/mcL (reference range, 4,500-11,000/mcL)

  • Ferritin level: 92 ng/mL (reference range, 10-120 ng/mL)

  • C-reactive protein level: 110 mg/dL (reference range, <10 mg/L)

  • Alkaline phosphatase level: 35 U/L (reference range, 44-147 U/L)

  • Albumin level: 3.7 g/dL (reference range, 3.4-5.4 g/dL)

  • Sodium level: 141 mEq/L (reference range, 135-145 mEq/L)

  • Potassium level: 4.6 mEq/L (reference range, 3.6-5.2 mEq/L)

  • Creatinine level: 1 mg/dL (reference range, 0.7-1.2 mg/dL)

  • Urea nitrogen level: 10 mg/dL (reference range, 7-20 mg/dL)

Urinalysis is negative for blood, protein, and white blood cells. The specific gravity is 1.012. Stool examination for ova, parasite, and Clostridium difficile toxin are all negative.

Colonoscopy shows a continuous edematous, hyperemic, and friable mucosa of a granular pattern in the rectosigmoid (Figure 1). No masses are found. Although this patient did not have surgical resection at this time, a typical gross appearance of disease is seen (Figure 2).

Figure 1.

Figure 2.

Figure 3.

Figure 4.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.