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The investigation of iron deficiency anemia--a hospital based audit.

AbstractBACKGROUND/AIMS:
Iron deficiency anemia (IDA) is associated with an increased incidence of malignancy. Our aim was to audit the management of patients with IDA seen in a teaching hospital gastroenterology unit, and to assess the role of upper and lower gastrointestinal endoscopy as well as mesenteric angiography in improving the diagnostic yield.
METHODOLOGY:
A retrospective review of all outpatient letters and in-patient discharge summaries in an 11 month period in 1996 was used to identify anemic patients. All endoscopic and radiological procedures were documented on these patients.
RESULTS:
98 cases (46 male) of IDA were identified. Of these, 94% had upper GI endoscopy with a yield for potential bleeding sources of 54% (including 4 malignancies) and 84% had lower GI investigation by colonoscopy or barium enema with a diagnostic yield of 37% (including 3 malignancies and 10 adenomatous polyps). Combined endoscopic and barium examinations provided a positive diagnosis in 69%, and 12.2% had significant co-existent upper and lower GI pathology. Thirty-three patients underwent visceral angiography (27 of who had no positive endoscopic diagnosis). Twenty-seven studies revealed a bleeding source (yield 82%). Overall an underlying diagnosis was made in 92% of patients.
CONCLUSIONS:
The incidence of significant dual pathology in patients with IDA was high. Investigation of the lower GI tract should be performed in all patients unless a malignancy is found on upper GI endoscopy. Mesenteric angiography has a high diagnostic yield, and is a useful investigation in patients with resistant or transfusion dependent anemia in whom endoscopic or barium studies are normal.
AuthorsJ O Lindsay, S D Robinson, J E Jackson, J R Walters
JournalHepato-gastroenterology (Hepatogastroenterology) 1999 Sep-Oct Vol. 46 Issue 29 Pg. 2887-90 ISSN: 0172-6390 [Print] Greece
PMID10576367 (Publication Type: Journal Article)
Chemical References
  • Barium Sulfate
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Anemia, Iron-Deficiency (diagnosis, epidemiology, etiology)
  • Barium Sulfate
  • Comorbidity
  • Endoscopy, Gastrointestinal
  • Female
  • Gastrointestinal Hemorrhage (diagnosis, epidemiology, etiology)
  • Gastrointestinal Neoplasms (diagnosis, epidemiology)
  • Hospitals, Teaching (statistics & numerical data)
  • Humans
  • London (epidemiology)
  • Male
  • Medical Audit (statistics & numerical data)
  • Middle Aged
  • Patient Discharge (statistics & numerical data)
  • Retrospective Studies

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