Hook worm caused chronic anemia found during the procedure of acute gastrointestinal bleeding: a case report
© Zhao et al; licensee BioMed Central Ltd. 2009
Received: 04 September 2008
Accepted: 30 January 2009
Published: 30 January 2009
Upper gastrointestinal bleeding with complicated factors is always difficult to find the primary origin.
Here we present a case of a 74-year-old male farmer suffered from acute upper gastrointestinal bleeding caused by gastric ulcer and Mallory-Weiss syndrome and chronic anemia which was at last found caused by hook worm infection.
It tells us that considering multi-possibility when can not explain the symptom with monophyletism is very important for clinicians.
Upper gastrointestinal bleeding is common in GI department, but the reasons for bleeding are sometimes complicated. We present a case of a male old farmer who suffered from recurrent acute gastrointestinal bleeding with chronic anemia caused by hook worm infection. And this case gives us a lesson to consider multi-reason for bleeding when can't explain the symptom with one etiology. And it also tells us the necessity of recurrent urgent endoscopy.
A 74-year-old farmer was evaluated for 5 hours of hematemesis and black stools. He denied abdominal pain, or diarrhea, but admitted to take "Fenbid, Indometacin and Metronidazole" because of toothache one day ago. No abnormal past history.
He was afebrile with a pulse of 84 beats per minute, blood pressure of 14.7/9.3 kPa, respirations of 18 breaths per minute. The abdominal exam was normal. His hemoglobin value was 6.0 g/dL (13.9–18.0 g/dL), MCV 70.1 fl (82–92 fl), MCH 21.0 pg (2.0–31.0 pg), MCHC302.2 g/L (310–380 g/L), HCT 0.209(0.37–0.49). OB (++++), liver and renal function and tumor markers were normal.
Etiology of upper gastrointestinal bleeding.
Erosion of stomach and duodenum
Malignant disease of the upper gastrointestinal tract
For the patients whose first symptom presented as acute upper gastrointestinal bleeding, but were found chronic microcytic, hypo chromic anemia, it was especially important to consider multi-reason possibility. In this case, chronic blood loss caused by hook warm infection could be the reasonable explanation of unmatchable small volume of hemorrhage at the beginning and heavy grade of microcytic, hypo chromic anemia. The attachment of hookworms' cutting organs to the intestinal mucosa and submucosa and the subsequent rupture of intestinal capillaries and arterioles cause blood loss. Males especially who are involved with agricultural pursuits as the patient in our case are more commonly infected with hookworm than females[2, 3]. The patient was diagnosed of upper GI bleeding because of gastric ulcer in the first upper endoscopy. The ulcer might be induced by the medicine he took, but the ulcer was surfaced with white fur without active bleeding when being found. Hematemesis and melena and even shock presented recurrently after expectant treatment. Second endoscopy found Mallory-Weiss syndrome, which was mainly caused by intensive vomiting and retch. And sometimes it can cause fresh blood hematemesis and hemodynamic instability. [4, 5]Both the ulcer and Mallory-Weiss with bleeding could be treated through the endoscope. Recurrent urgent upper endoscopy could not only advance the detective rate of etiology for upper gastrointestinal bleeding, but also carry out the hemostasis through it.
A patient suffered from acute recurrent gastrointestinal bleeding accompanied with chronic anemia gave us a lesson that we should consider multi-reason existing when we could not explain the symptom with monophyletism.
A written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent will be made available on request.
mean corpuscular volume
mean corpuscular hemoglobin
mean corpuscular hemoglubin concentration
Hematocrit in blood
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