Fatigued

Blood & Lymphoreticular System


{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This elderly lady has presented with a 3 week history of melena; this is an extremely concerning presentation which raises the spectre of upper gastrointestinal (GI) bleeding. Note that the presence of pallor lends further credence to this possibility.\n\nHer examination reveals another disconcerting finding: massive splenomegaly (i.e. a spleen which extends 8 cm or more beyond the costal margin). This sign is caused by only a few conditions; of these, it is only myelofibrosis and chronic myeloid leukemia (CML) which are likely to present in this manner.\n\nNote also that she is icteric; this might be due to involvement of the liver in the disease process; alternately, it might be due to hemolysis secondary to hypersplenism.\n\nFortunately, her v"}]}

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