scholarly journals 1437 Histological Examination in Search of Helicobacter Pylori in Iron Deficiency Anaemia: An Unnecessary Expense?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Y Abdallah ◽  
S Maryosh ◽  
C Caldwell ◽  
Ahmad Zia ◽  
H Fellows
Keyword(s):  
Helicobacter Pylori ◽  
Iron Deficiency ◽  
Histological Examination ◽  
Iron Deficiency Anaemia ◽  
Cost Effective ◽  
British Society ◽  
Improvement Project ◽  
Deficiency Anaemia ◽  
Weak Evidence ◽  
Cost Effective Alternative

Abstract Aim The British Society of Gastroenterology guidelines recommend Helicobacter pylori (HP) testing in patients with iron deficiency anaemia (IDA). This quality improvement project evaluates the utility of histological examination for HP in IDA patients, the consequent expenditure and whether a more cost-effective alternative exists. Method A retrospective search was conducted of patients within a four-month period who underwent an oesophago-gastroduodenoscopy (OGD) for IDA. Patients with an identifiable cause of IDA, ferritin >40ug/mL and haemoglobin (Hb) >12g/L in women or > 13g/L in men were excluded. The costings of a single tissue biopsy and HP stool testing were sought from our local departments. Results Ninety-nine patients’ results were analysed after exclusions (n = 99/127, 78.0%). All patients had biopsies taken at OGD. On average, three biopsies were obtained per patient. Forty-two patients had no abnormalities visualized on OGD and all ninety-nine patients were HP negative. A single biopsy costs £70; £65 per hematoxylin and eosin based histological examination and £5 per single-use biopsy forceps. Accounting for forty-two patients with macroscopically normal OGDs leads to a total expenditure of £8820. A HP stool test costs £14. Conclusions Guidelines recommend HP testing either non-invasively or at OGD as an alternative strategy, based on weak evidence that HP may cause IDA. HP prevalence is falling; histological examination of biopsies obtained at OGD therefore appears expensive and unnecessary. It is more cost effective to perform a stool test in the case of a normal OGD and commence treatment accordingly with biopsies reserved when otherwise clinically indicated and not solely for HP testing.

463 THE USE OF FERINJECT TO MANAGE IRON DEFICIENCY ANAEMIA IN PATIENTS WITH NECK OF FEMUR FRACTURES

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
O Meakin ◽  
S Adejumo
Keyword(s):  
Iron Deficiency ◽  
Patient Group ◽  
Iron Deficiency Anaemia ◽  
Eligible Patient ◽  
Blood Transfusions ◽  
Neck Of Femur ◽  
Improvement Project ◽  
Deficiency Anaemia ◽  
Femur Fractures ◽  
Iron Deficient

Abstract Introduction Iron-deficiency anaemia is a condition that is regularly seen in patients admitted with neck of femur fractures (NOFF) and is associated with increased morbidity peri-operatively. Intravenous ferinject is a method of iron replacement that leads to a more rapid increase in haemoglobin than oral replacement, therefore is often more favourable in this patient group, leading to better patient outcomes. Method A quality improvement project was undertaken. An initial audit was conducted to analyse the demographic of patients with NOFF and to assess the current practice of the orthogeriatric team when managing iron deficiency anaemia. This reviewed NOFF patients admitted in July 2017. The indications and benefits of ferinject were distributed to the medical team, encouraging use clinically, and a further audit was performed 2 years later to compare outcomes and practice, reviewing patients with NOFF admitted July–September 2019. Results It was found that 87% of patients with NOFF are iron-deficient on admission, and that introducing the use of ferinject meant that 50% fewer blood transfusions were required. Additionally, it highlighted that those who received ferinject during their admission had a smaller range of discharge haemoglobin levels than those who did not. Finally, it was found that the use of ferinject did not affect the rates of readmission in the assessed patient cohort. Conclusions The introduction of the use of ferinject in NOFF patients with iron-deficiency anaemia leads to a reduction in the requirement of blood transfusions required and to a reduction of the range of discharge haemoglobin levels. Ferinject therefore aids in improved recovery of NOFF patients. It does not, however, appear to have any effect on readmission rates in this patient group. Further education is required amongst the orthogeriatric team about the indications and benefits of ferinject to ensure that all eligible patient receive ferinject, improving their recovery.

The use of faecal immunochemical testing in the decision-making process for the endoscopic investigation of iron deficiency anaemia

2020 ◽  
Vol 58 (2) ◽  
pp. 232-239
Author(s):  
Lorena Rodriguez-Alonso ◽  
Francisco Rodriguez-Moranta ◽  
Alexandra Ruiz-Cerulla ◽  
Claudia Arajol ◽  
Katja Serra ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Postmenopausal Women ◽  
Iron Deficiency Anaemia ◽  
Cost Effective ◽  
Accurate Method ◽  
Diagnostic Study ◽  
Gi Tract ◽  
Deficiency Anaemia ◽  
Blood Haemoglobin ◽  
A Prospective Study

AbstractBackgroundBlood loss from the gastrointestinal (GI) tract is the most common cause of iron deficiency anaemia (IDA) in adult men and postmenopausal women. Gastroduodenal endoscopy (GDE) and colonoscopy are frequently recommended, despite uncertainty regarding the coexistence of lesions in the upper and lower GI tract. The faecal immunochemical test (FIT) measures the concentration of faecal haemoglobin (f-Hb) originating only from the colon or rectum. We aimed to assess whether the FIT was able to select the best endoscopic procedure for detecting the cause of IDA.MethodsA prospective study of 120 men and postmenopausal women referred for a diagnostic study of IDA were evaluated with an FIT, GDE and colonoscopy. The endoscopic finding of a significant upper lesion (SUL) or a significant bowel lesion (SBL) was considered to be the cause of the IDA.ResultsThe diagnoses were 35.0% SUL and 20.0% SBL, including 13.3% GI cancer. In the multivariate analysis, the concentration of blood haemoglobin (b-Hb) <9 g/dL (OR: 2.60; 95% CI 1.13–6.00; p = 0.025) and non-steroidal anti-inflammatory drugs NSAIDs (2.56; 1.13–5.88; p = 0.024) were associated with an SUL. Age (0.93; 0.88–0.99; p = 0.042) and f-Hb ≥ 15 μg Hb/g faeces (38.53; 8.60–172.50; p < 0.001) were associated with an SBL. A “FIT plus gastroscopy” strategy, in which colonoscopy is performed only when f-Hb ≥15 μg Hb/g faeces, would be able to detect 92.4% of lesions and be 100% accurate in the detection of cancer while avoiding 71.6% of colonoscopies.ConclusionsThe FIT is an accurate method for selecting the best endoscopy study for the evaluation of IDA. An FIT-based strategy is more cost-effective than the current bidirectional endoscopy-based strategy and could improve endoscopic resource allocation.

scholarly journals Addressing Female Iron-Deficiency Anaemia in India: Is Vegetarianism the Major Obstacle?

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Anu Rammohan ◽  
Niyi Awofeso ◽  
Marie-Claire Robitaille
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Large Scale ◽  
Public Health Problem ◽  
Cost Effective ◽  
Vegetarian Diet ◽  
Major Public Health Problem ◽  
Daily Consumption ◽  
Indian Women ◽  
Deficiency Anaemia

Objectives. We examined the influence of vegetarian diet on the risk of developing anaemia among Indian women and suggest initiatives for addressing diet-related iron-deficiency anaemia. Methods. We analysed data on diet, social class, and haemoglobin levels from the nationally representative Indian National Family and Health Survey 2005/06 for a sample of 81,301 women aged 15–49 years using logistic regression models. Results. After controlling for individual-level factors and household level socioeconomic characteristics, daily consumption of meat, fish, and eggs was associated with lower odds of being moderately or severely anaemic. Our analysis also revealed that economic characteristics such as being from higher wealth quintiles, being in paid employment, and rural residence reduced the odds of having iron-deficiency anaemia among Indian women. Discussion. As a large proportion of Indians subsist on iron-poor vegetarian diets for religious, economic, and cultural reasons, large-scale iron supplementation and fortification of commonly consumed vegetarian foodstuffs constitute a feasible, culturally appropriate, and cost-effective strategy for addressing this major public health problem. Consumption of cheap iron-rich foodstuffs should be promoted. Effective poverty alleviation and hookworm prevention programs are also important. Large-scale cohort and intervention studies are urgently required to further define the influence of vegetarianism on iron deficiency anaemia in India.

scholarly journals Iron deficiency anaemia: further education regarding the British Society of Gastroenterology guidelines is required

Gut ◽  
2007 ◽  
Vol 56 (9) ◽  
pp. 1319-1319 ◽  
Author(s):  
K. Gregory ◽  
M. Halliday ◽  
C. Averill ◽  
N. Bhala ◽  
C. Tselepis ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Further Education ◽  
British Society ◽  
Deficiency Anaemia
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