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Tumour Haemorrhage — SCE Medical Oncology MCQ

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HardOncological EmergenciesTumour HaemorrhageSCE Medical Oncology

A 58-year-old woman on chemotherapy develops acute lower GI haemorrhage from a known rectal tumour. She is haemodynamically unstable (HR 120, BP 85/50). Hb is 52 g/L. Platelets are 45 × 10⁹/L (chemotherapy-induced). What is the immediate management?

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Correct answer: D — Resuscitate: major haemorrhage protocol activation (transfuse RBC, platelets, FFP/cryoprecipitate in 1:1:1 ratio), correct coagulopathy, endoscopic assessment/intervention when stabilised; surgery is a last resort in this context

Acute tumour haemorrhage in a thrombocytopenic chemotherapy patient requires: (1) major haemorrhage protocol (RBC + platelets + FFP in balanced ratio), (2) correct specific deficits (platelets >50 for active bleeding, fibrinogen >1.5), (3) tranexamic acid 1g IV (anti-fibrinolytic), (4) endoscopic assessment when haemodynamically stable (cauterisation, adrenaline injection, clipping), (5) angiographic embolisation if endoscopy fails, (6) palliative RT (single fraction) for recurrent tumour bleeding once stabilised. Emergency surgery is reserved for life-threatening uncontrollable bleeding.

Reference: NICE NG24 Blood transfusion; ESMO Oncological Emergencies; BSG GI bleeding guidelines