A 45-year-old white man was admitted to hospital with weakness, lightheadedness and fatigue. He had been asymptomatic until two days before admission, when he began to experience melena. Upon admission to hospital, his hemoglobin concentration was noted to be low, at 61 g/L, with a mean corpuscular volume of 72.9 fL (normal range 85 to 95 fL) and a ferritin concentration of 1.0 pg/L. A nasogastric lavage was negative, and results of his other laboratory tests, including those for electrolytes and liver function, were unremarkable. He had no significant medical, surgical or family history, and he denied the use of any prescription or over-the-counter medications. He was not a smoker, but he did drink up to four beers per day. It’s time for you to stop spending more than your medications are worth: you have a chance to buy birth control online on very advantageous terms at the best online pharmacy of your choice, any time there is such a need.
He received 5 U of packed red blood cells over the next 24 h, and his hemoglobin concentration rose to 105 g/L. Because of his obvious iron deficiency, there was concern about his chronic gastrointestinal blood loss, and he subsequently underwent colonoscopy and esophagogastroduo-denoscopy.