Gastric adenocarcinoma often presents with which hematologic finding?

Gastric adenocarcinoma often presents with which hematologic finding?

• A. Macrocytic anemia
• B. Elevated ALP only
• C. Microcytic anemia from bleeding; endoscopy with biopsy
• D. Negative stool occult blood

Answer: (C)

Iron deficiency from chronic blood loss is a common presenting feature of gastric adenocarcinoma. The tumor sheds small amounts of blood over time, depleting iron and producing a microcytic, iron-deficiency pattern on labs. This is why microcytic anemia from bleeding is the best fit. To confirm the diagnosis of the underlying cancer, the needed next step is endoscopy with biopsy, which directly visualizes the lesion and provides tissue for histology. Other options don’t fit as well: macrocytic anemia would point toward different causes such as B12/folate deficiency or alcohol use; isolated elevation of alkaline phosphatase is not a hematologic finding; negative stool occult blood would be unlikely given the typical occult bleeding from the tumor.

Iron deficiency from chronic blood loss is a common presenting feature of gastric adenocarcinoma. The tumor sheds small amounts of blood over time, depleting iron and producing a microcytic, iron-deficiency pattern on labs. This is why microcytic anemia from bleeding is the best fit. To confirm the diagnosis of the underlying cancer, the needed next step is endoscopy with biopsy, which directly visualizes the lesion and provides tissue for histology. Other options don’t fit as well: macrocytic anemia would point toward different causes such as B12/folate deficiency or alcohol use; isolated elevation of alkaline phosphatase is not a hematologic finding; negative stool occult blood would be unlikely given the typical occult bleeding from the tumor.