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A 59-year-old presented with a 2-week history of fatigue, shortness of breath and pale appearance. Medical history included osteoarthritis of both hips for which he was on regular non-steroidal anti-inflammatory drugs (NSAIDs). There was no significant personal, social or family history. No gastrointestinal (GI) symptoms were reported, and no clinical signs of overt GI bleeding were noted. Clinical examination was unremarkable apart from hypertension (186/107) and tachycardia (pulse 118/min). Laboratory tests showed marked microcytic anaemia with haemoglobin (Hb) of 45 g/L, mean corpuscular volume of 67 fL and ferritin of 8 ng/mL, requiring blood transfusion. An inpatient gastroscopy was organised which only showed mild gastritis but no obvious cause for this significant drop in Hb was identified. A presumptive diagnosis of NSAID-related chronic GI bleeding was kept …
Contributors MS: senior house office; wrote the script, analysed literature. GN: registrar; edited the script, amended references. MF: consultant pathologist; analysed the pathology slides and provided. MA: consultant under whom the patient was admitted; supervised and guided with the structure and content of the script.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.