Unexpected findings in a patient presenting with melena

Aims A 67-year-old current smoker male was admitted to the emergency room for weakness and melena after a seven-day treatment of non-steroidal anti-inflammatory drugs (NSAIDs) for rib fracture. He had a past history of high-grade urothelial carcinoma (pT1, G3) treated by Transurethral Resection of the Bladder (TURB) and a re-TURB eight weeks later and followed up by a biannual urological assessment. Complete blood count showed a hemoglobin concentration of 45 g/L (normal 140–168 g/L). Platelet count, coagulation, renal and liver function tests were normal.