What are the expected complete blood count (CBC) findings in a patient with peptic ulcer disease?

Expected CBC Findings in Peptic Ulcer Disease

The most common CBC finding in peptic ulcer disease is anemia, particularly iron deficiency anemia, due to chronic blood loss from the ulcer site. 1

Key CBC Findings

Primary Finding:

• Anemia: Typically presents as:
  • Decreased hemoglobin (<120 g/L in women, <130 g/L in men)
  • Decreased hematocrit
  • Microcytic, hypochromic red blood cells (in chronic blood loss)

Severity of Anemia:

The severity of anemia correlates with:

• Duration of bleeding
• Rate of blood loss
• Size of the ulcer
• Location of the ulcer

Hemoglobin levels <100 g/L are associated with a 3.3-fold increased risk of rebleeding within 3 days 2.

Risk Assessment

The Glasgow-Blatchford Score (GBS) uses hemoglobin levels as a key component to risk-stratify patients with suspected upper GI bleeding 3:

• Hemoglobin <80 g/L: 4 points
• Hemoglobin 80-99 g/L: 3 points
• Hemoglobin 100-119 g/L: 2 points
• Hemoglobin ≥120 g/L: 1 point

Other Potential CBC Findings

1. White Blood Cell Count:

   • May be normal in uncomplicated peptic ulcer disease
   • May be elevated in cases of perforation or significant inflammation

2. Platelet Count:

   • Usually normal
   • May be elevated (reactive thrombocytosis) in response to chronic blood loss
   • May be decreased in cases of severe acute bleeding due to consumption

Clinical Significance

• Initial hemoglobin <10 g/dL is an independent risk factor for rebleeding (OR 3.3) 2
• Blood transfusions should be administered when hemoglobin levels fall below 70 g/L in most patients 1
• Higher transfusion thresholds (80-100 g/L) may be warranted in patients with underlying cardiac disease 1

Monitoring Considerations

• Serial CBC measurements are essential to monitor:

  • Response to treatment
  • Ongoing blood loss
  • Need for blood transfusion

• Rapid drops in hemoglobin may indicate active bleeding requiring urgent intervention

• Stable hemoglobin levels after treatment suggest successful management

Pitfalls in Interpretation

1. Acute Bleeding: Initial hemoglobin may appear normal despite significant blood loss due to delayed hemodilution
2. Dehydration: May mask the true degree of anemia due to hemoconcentration
3. Comorbidities: Baseline anemia from other causes may complicate interpretation

In conclusion, while anemia is the hallmark CBC finding in peptic ulcer disease, the complete clinical picture including vital signs, symptoms, and endoscopic findings should guide management decisions.