Approach to hematochezia (pediatrics) Quiz: Ace Your Exams
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A 2-year-old boy is brought to the emergency department for evaluation of large-volume bright red blood per rectum for 4 hours and lethargy. A caregiver reports that the bleeding began suddenly and soaked through two diapers. There is no history of fever, vomiting, abdominal pain, diarrhea, trauma, or recent illness. Temperature is 36.7°C (98.1°F), blood pressure is 66/34 mmHg, heart rate is 142 beats per minute, respiratory rate is 34 breaths per minute, and oxygen saturation is 99% on room air. The extremities are cool with a capillary refill time of 4 seconds. Abdominal examination reveals no tenderness or guarding. There are no visible anal fissures or signs of external trauma. A chaperoned digital rectal examination reveals bright red blood. Initial laboratory studies are displayed below. Which of the following is the next best step in management?
| Laboratory Value | Result |
| Hemoglobin | 6.8 g/dL |
| Hematocrit | 23% |
| Platelet count | 310,000/µL |
| White blood cell count | 12,000/µL |
| Blood urea nitrogen | 7 mg/dL |
| Creatinine | 0.6 mg/dL |
| Prothrombin time (PT) | 12.1 seconds |
| Partial thromboplastin time (PTT) | 33 seconds |
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