1.

A

65-year-old woman weighing 50 kg is admitted to hospital because of increased

fatigue, weakness and dyspnea on exertion. Other than three previous uncomplicated

pregnancies, she has had no other hospitalization or medical problems.

Vital signs are: pulse 106

beats per minute, blood pressure 110/76 mmHg, sitting and supine, and

respiratory rate 24 per minute. With the exception of pallor and flow murmur,

the remainder of her physical examination is completely normal.

Her Hb is 65 g/L (6.5 g/dL)

and her Het is 19%, with hypochromic microcytic cells noted on the peripheral

smear. Her stools are strongly positive for occult blood. A barium enema

reveals a tumor in the ascending colon. The CEA level is elevated at 250 ug/L

(250 ng/mL). Metastatic work-up is negative. Serum electrolytes, liver enzymes,

plasma protein, urea, glucose and bilirubin are all normal as well as screening

coagulation tests. She is scheduled for surgery.