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Friday, 4 March 2016

Anemia and Abdominal Bruit

A 60 year old man presented with history of dizziness and fatigue for  2 days.  He noticed melena 3 days earlier.
He has otherwise no other significant symptoms.
He had previously once hospitalized because of severe iron deficiency anemia and was
transfused 6 units of packed red blood cells.

He noticed little nose bleeds several times over the preceding years.
His medications were lisinopril  OD for hypertension, and atorvastatin for dyslipidemia.

On examination he was pale, non-icteric and of average body build.
His standing BP was is 100/60, and supine was 110/60.
There were small red spots on the tongue, fingers and nail plates.
Clubbing of fingers was also noted.

Heart and chest examination was normal
Abdominal examination revealed a clear bruit heard over the RUQ.

His Hb was 7,.  MCV was 67, and serum ferritin was low.
Platelet count and INR were normal.

The most likely diagnosis is Hereditary Hemorrhagic Telangiectasia.
A bruit over the RUQ indicated the presence of hepatic AV shunting.

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