Case 90 – the beginning

A 74 year old male is admitted to hospital with weight loss, fatigue and change in bowel habit. He is pale and a mass is palpated in the right iliac fossa. A full blood count is performed:

  • Hb 72g/l
  • MCV 72fl
  • WCC 12.8×109/l
  • Neutrophils 8.9×109/l
  • Platelets 501×109/l

A colonic malignancy is suspected and colonoscopy is requested. Prior to this a blood transfusion is suggested. Two units of red cells are requested and given. At the end of the second unit the patient complains of breathlessness and on the observations the oxygen saturation has fallen from 97% to 90%. The house officer (FY1) is called by the nursing staff.


  • What questions would you ask the patient?
  • What would you look for on examination and how would you approach this scenario?
  • What tests may you request?


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