A 64-year-old woman was presented with symptomatic anemia and several episodes of painless rectal bleeding. During an initial assessment, the patient states that she "can hardly walk" and that she has dyspnea on exertion, chest pain, and "ringing in the ears. Her blood pressure is 144/70 mm Hg. Significant orthostatic changes are noted in the patient's pulse and blood pressure. Her respiratory rate is 24 breaths/min, with mildly increased work of breathing.
She appears pale and cachectic, and her oral mucosa is observed to be dry. Rectal examination reveals dark red blood in the rectum. The rest of the physical examination is unremarkable, except for external hemorrhoids without visible active bleeding. Laboratory examinations, however, reveal a hemoglobin level of 3.6 g/dL, a hematocrit of 12.2%, a platelet count of 295 × 103 cells/µL, a prothrombin time of 12.3 sec, and a partial…
