77-year-old gentleman, underlying hypertension on Tablet Amlodipine 10mg, came to us for bilateral pedal edema for months.
Blood test was ordered to investigate the kidney functions. However, incidental noted to have:
1) Very high erythrocyte sedimentation rate(ESR) – level >100mm/Hr
2) Unexplained iron deficiency anaemia(IDA)
He was then referred to tertiary center for further management.
Final Diagnosis: Stage II Transverse Colon Carcinoma
Retrospectively, this gentleman has no bowel symptoms, reduced appetite and weight reduced 2 kilos over the past few weeks. No mass felt per abdomen.
As a rule of thumb, when ESR level >100mm/Hr, there are only a few causes:
1. Tuberculosis(TB)
2. Severe infection/inflammation
3. Cancer
Blood investigations highly suggestive of colon cancer due to the presence of IDA. Patient with colon cancer tend to have occult blood loss which might lead to unexplained IDA during blood investigations.