Lanthanum phosphate binder-induced iron deficiency anaemia

Lanthanum carbonate is a phosphate binder that is used to reduce serum phosphate levels in patients with end-stage renal disease (ESRD). Lanthanum forms insoluble lanthanum phosphate complexes that are supposed to pass through the gastrointestinal (GI) tract unabsorbed. Phosphate binders have been reported to deposit in the GI tract and can cause mucosal injury. There are few case reports of GI bleeding associated with phosphate binder deposits. This case report presents a patient with iron deficiency anaemia secondary to biopsy-proven lanthanum deposits in the upper GI tract. There were no overt signs of active GI bleeding. Patient’s anaemia improved with discontinuation of the phosphate binder. Lanthanum could be a hidden cause of resistant anaemia among patients with ESRD through asymptomatic GI blood loss.

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Systematic review to investigate the safety of induction and augmentation of labour among pregnant women with iron-deficiency anaemia

BMJ Open ◽

10.1136/bmjopen-2018-021793 ◽

2018 ◽

Vol 8 (12) ◽

pp. e021793 ◽

Cited By ~ 1

Author(s):

Kathryn Bunch ◽

Nia Roberts ◽

Marian Knight ◽

Manisha Nair

Keyword(s):

Systematic Review ◽

Iron Deficiency ◽

Pregnant Women ◽

Iron Deficiency Anaemia ◽

Case Reports ◽

Case Series ◽

Severe Anaemia ◽

Risk Of Bias ◽

Deficiency Anaemia ◽

Increased Risk

ObjectiveTo conduct a systematic review to investigate the safety of induction and/or augmentation of labour compared with spontaneous-onset normal labour among pregnant women with iron-deficiency anaemia.DesignSystematic review.SettingStudies from all countries, worldwide.PopulationPregnant women with iron-deficiency anaemia at labour and delivery.InterventionAny intervention related to induction and/or augmentation of labour.Outcome measuresPrimary: Postpartum haemorrhage (PPH), heart failure and maternal death. Secondary: Emergency caesarean section, hysterectomy, admission to intensive care unit.MethodWe searched 10 databases, including Medline and Embase, from database inception to 1 October 2018. We included all study designs except cross-sectional studies without a comparator group, case reports, case series, ecological studies, and expert opinion. The searches were conducted by a healthcare librarian and two authors independently screened and reviewed the studies. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approachto ascertain risk of bias and conducted a narrative synthesis.ResultsWe identified 3217 journal articles, 223 conference papers, 45 dissertations and 218 registered trials. Ten articles were included for full-text review and only one was found to fulfil the eligibility criteria. This was a retrospective cohort study from India, which showed that pregnant women with moderate and severe anaemia could have an increased risk of PPH if they underwent induction and/or augmentation of labour, but the evidence was weak (graded as ‘high risk of bias’).ConclusionThe best approach is to prevent anaemia, but a large number of women in low-to-middle-income countries present with severe anaemia during labour. In such women, appropriate peripartum management could prevent complications and death. Our review showed that at present we do not know if induction and augmentation of labour is safe in pregnant women with iron-deficiency anaemia and further research is required.PROSPERO registration numberCRD42015032421.

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

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2019-0203 ◽

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.

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The dedicated iron deficiency anaemia clinic: a 15-year experience

Frontline Gastroenterology ◽

10.1136/flgastro-2020-101470 ◽

2020 ◽

pp. flgastro-2020-101470

Author(s):

Helen Stone ◽

Orouba Almilaji ◽

Christopher John ◽

Carla Smith ◽

Susan L Surgenor ◽

...

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anaemia ◽

Diagnostic Yield ◽

Referral Rate ◽

Gi Tract ◽

Right Colon ◽

Deficiency Anaemia ◽

Study Population ◽

The Right ◽

Cumulative Experience

ObjectiveTo report our cumulative experience from a dedicated iron deficiency anaemia (IDA) clinic over the last 15 years—with particular emphasis on referral rate, uptake of investigation, impact on endoscopy services, diagnostic yield of gastrointestinal (GI) investigation and the issue of recurrent IDA.MethodA series of analyses of a register of 2808 referrals to the Poole IDA clinic between 2004 and 2018.ResultsThe study population of 2808 had a sex ratio of 1.9 (female/male ratio) and a median age of 72 years (IQR: 60–79). A rising referral rate over the study period appears to be plateauing at around 2 cases per 1000 population per annum. On the basis of a snapshot audit, investigation of IDA may now account for over 20% of all diagnostic endoscopies.Overall, 86% of cases underwent examination of the upper and lower GI tract. Significant GI pathology was identified in 27% of the investigated cohort. Adenocarcinoma of the upper or lower GI tract was found in 8.3%, the majority in the right colon. The prevalence of recurrent IDA was estimated at 12.4%, and the results of investigation of this subgroup are reported.ConclusionUnexplained IDA is common, particularly in those over 60 years, and may be the first indication of underlying GI malignancy in over 8% of cases. Unresolved challenges include accommodating the resulting endoscopy workload, establishing a risk/benefit ratio for investigating those with major comorbidities and the management of recurrent IDA.

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British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults

Gut ◽

10.1136/gutjnl-2021-325210 ◽

2021 ◽

pp. gutjnl-2021-325210

Author(s):

Jonathon Snook ◽

Neeraj Bhala ◽

Ian L P Beales ◽

David Cannings ◽

Chris Kightley ◽

...

Keyword(s):

Iron Deficiency ◽

Blood Loss ◽

Burden Of Disease ◽

Secondary Care ◽

Iron Deficiency Anaemia ◽

Symptom Relief ◽

British Society ◽

Common Mechanism ◽

Gi Tract ◽

Deficiency Anaemia

Iron deficiency anaemia (IDA) is a major cause of morbidity and burden of disease worldwide. It can generally be diagnosed by blood testing and remedied by iron replacement therapy (IRT) using the oral or intravenous route. The many causes of iron deficiency include poor dietary intake and malabsorption of dietary iron, as well as a number of significant gastrointestinal (GI) pathologies. Because blood is iron-rich it can result from chronic blood loss, and this is a common mechanism underlying the development of IDA—for example, as a consequence of menstrual or GI blood loss.Approximately a third of men and postmenopausal women presenting with IDA have an underlying pathological abnormality, most commonly in the GI tract. Therefore optimal management of IDA requires IRT in combination with appropriate investigation to establish the underlying cause. Unexplained IDA in all at-risk individuals is an accepted indication for fast-track secondary care referral in the UK because GI malignancies can present in this way, often in the absence of specific symptoms. Bidirectional GI endoscopy is the standard diagnostic approach to examination of the upper and lower GI tract, though radiological scanning is an alternative in some situations for assessing the large bowel. In recurrent or refractory IDA, wireless capsule endoscopy plays an important role in assessment of the small bowel.IDA may present in primary care or across a range of specialties in secondary care, and because of this and the insidious nature of the condition it has not always been optimally managed despite the considerable burden of disease— with investigation sometimes being inappropriate, incorrectly timed or incomplete, and the role of IRT for symptom relief neglected. It is therefore important that contemporary guidelines for the management of IDA are available to all clinicians. This document is a revision of previous British Society of Gastroenterology guidelines, updated in the light of subsequent evidence and developments.

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Unusual cause of severe iron deficiency anaemia in a child: paraoesophageal hernia

BMJ Case Reports ◽

10.1136/bcr-2020-237728 ◽

2021 ◽

Vol 14 (3) ◽

pp. e237728

Author(s):

Rishi Bolia ◽

Yash Srivastava ◽

Renu Yadav ◽

Poonam Sherwani

Keyword(s):

Iron Deficiency ◽

Hiatus Hernia ◽

Iron Deficiency Anaemia ◽

Gastrointestinal Endoscopy ◽

Case Reports ◽

Occult Blood ◽

Upper Gastrointestinal Endoscopy ◽

Deficiency Anaemia ◽

Paraoesophageal Hernia ◽

Upper Gastrointestinal

Iron deficiency anaemia is a known complication of a large hiatal hernia in adults. It occurs as a result of erosions on the gastric mucosa secondary to traction at the hiatus during respiration and/or gastric acid-related injuries to the mucosa. Even though anaemia occurs as a result of chronic gastrointestinal blood loss, testing for faecal occult blood is often negative and upper gastrointestinal endoscopy normal as the bleeding is intermittent. In children, a hiatus hernia as a rare cause of iron deficiency anaemia and has been described only in case reports. Here, we describe a 5-year-old boy who presented with severe transfusion-dependent iron deficiency anaemia caused by a paraoesophageal hernia. Surgical repair of the hiatus hernia led to complete resolution of anaemia. One should consider a hiatus hernia as a diagnostic possibility when evaluating a child with refractory iron deficiency anaemia.

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