A 30-year-old man with established ulcerative colitis presents with a flare consisting of bloody diarrhea 7 times per day. Which additional finding completes the Truelove and Witts definition of acute severe ulcerative colitis?
- A Transverse colon diameter greater than 6 cm on a plain abdominal radiograph
- B Heart rate above 90 beats/min, temperature above 37.8 degrees C, hemoglobin below 10.5 g/dL, and CRP above 30 mg/L ✓
- C Albumin below 35 g/L with more than 4 kg weight loss
- D Endoscopic evidence of deep ulceration involving the entire colon
Correct answer: B. Heart rate above 90 beats/min, temperature above 37.8 degrees C, hemoglobin below 10.5 g/dL, and CRP above 30 mg/L
Explanation
The Truelove and Witts criteria define acute severe UC as six or more bloody stools per day plus any one marker of systemic toxicity: pulse above 90/min, temperature above 37.8 degrees C, hemoglobin below 10.5 g/dL, or ESR above 30 mm/h (CRP above 30 mg/L is the modern equivalent). Transverse colonic dilatation greater than 6 cm defines toxic megacolon, a complication rather than part of this definition. Recognizing severity determines admission for intravenous steroids.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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