Background: Over the last two decades concerns have been raised about the potential risk of blood transfusion over the benefits. General restrictive red blood cell (RBC) transfusion approach for anemic hospitalized patients (thresh hold of 7 gm %) has been adopted by American hematology society (AHS) in 2012. It is important to recognize that guidelines [...]

Background: Unplanned readmissions among cancer patients are common and gastrointestinal (GI) cancer has some of the highest readmission volumes. Under the Affordable Care Act, hospitals have been getting penalized for excessive readmission rates. For now, the medical treatment of cancer is exempt from this measure. This is because the readmission profile of the cancer patient [...]

Background: Widespread use of new oral anticoagulants (NOAG) for Atrial Fibrillation (A-Fib) has increased the annual incidence of gastrointestinal bleed (GIB) in recent years. These NOAG agents in our study include Rivaroxaban, Apixaban and Dabigatran. Convenience of use, quick onset, broad therapeutic window and eliminating need for frequent monitoring makes NOAGs attractive for A-Fib associated [...]

Background: UGIB is a common cause of inpatient admissions often associated with morbidity and an overall mortality rate approaching 10%. Since therapy is different, it is important to differentiate between variceal and non-variceal GI bleeding. While both will often need volume resuscitation, proton pump inhibitors (PPI), judicious transfusion and early endoscopy, patients with variceal bleeding [...]

Case Presentation: A 65 year old African American male with a past medical history of non-obstructive CAD and chronic hepatitis C with cirrhosis presented to the emergency room with one episode of hematochezia.  Vital signs on presentation were significant for BP 104/61 and HR 103. A digital rectal exam revealed bright red blood. Labs were [...]

Case Presentation: An 80-year-old man with a past medical history of chronic lymphocytic leukemia, coronary artery disease, diabetic chronic kidney disease and heart failure reduced ejection fractionwith two months of intermittent hematochezia. Since onset of symptoms, the patient had required nine transfusions. His admission exam was remarkable for jugular venous distension, trace ankle edema, a [...]