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

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.

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 An Unusual Association between Unilateral Intracranial Vessels Occlusion with Iron Deficiency Anaemia and Alpha-Thalassemia Trait: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Yeong Yeh Lee ◽  
Shalini Bhaskar
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Vessel Occlusion ◽  
Cerebral Angiogram ◽  
Deficiency Anaemia ◽  
Intracranial Vessel ◽  
Unusual Association ◽  
Alpha Thalassemia ◽  
Thalassemia Trait ◽  
The Right

We report a 33-year-old Malay woman presented with acute left dense hemiparesis and an NIHSS score of 11/15. Computed tomography (CT) scan brain showed a massive right middle cerebral artery (MCA) territory infarct. The right internal carotid artery (ICA) and right proximal MCA were shown occluded from digital substraction angiography (DSA). Carotid dissection, carotid canal anomaly, and intercavernous communication were systematically ruled out. She had no risk factors for atherosclerosis. The connective tissue screening and thrombophilic markers were negative. However, she was anaemic on admission and subsequent investigations revealed that she had alpha-thalassemia and iron deficiency anaemia. The right ICA remained occluded from a repeat CT cerebral angiogram after one year, but otherwise she was neurologically stable. This case illustrates an unusual association between intracranial vessel occlusion with iron deficiency anaemia and alpha-thalassemia trait.

scholarly journals Video Capsule endoscopy in patients with Iron Deficiency Anaemia: Experience at a Regional Australian Service

2021 ◽  
Author(s):  
Maddison Furner ◽  
Robyn Nagel ◽  
Janani Pinidiyapathirage
Keyword(s):  
Iron Deficiency ◽  
Capsule Endoscopy ◽  
Iron Deficiency Anaemia ◽  
Diagnostic Yield ◽  
Video Capsule Endoscopy ◽  
Positive Finding ◽  
Diagnostic Modality ◽  
Deficiency Anaemia ◽  
Frequent Finding ◽  
Regional Australia

Abstract Background Few studies have examined the diagnostic yield of video capsule endoscopy (VCE) in patients with iron deficiency anaemia (IDA). This retrospective study aims to identify the yield of VCE, distribution of VCE findings in IDA and factors predictive of positive findings among patients presenting to a gasteroendoscopy practice in regional Australia. Methods Findings of consecutive VCE studies between March 2017 and April 2020 performed in patients with unexplained IDA and negative conventional endoscopy were included in this retrospective analysis. All endoscopies were performed and reported by a single specialist physician. Relevant clinical data including demographics, medication use, haemoglobin and ferritin levels were extracted into a standardised spreadsheet with procedural findings. A positive diagnostic yield was considered when VCE diagnosed one or more lesions that could explain the IDA. Statistical analysis was used to determine variables correlated with definite VCE findings. Results In total 123 procedures were included. Mean age of the patients was 67.9 years. Mean haemoglobin and ferritin levels were 93.3 g/L and 11.9ug/L, respectively. Positive findings were present in 54.5% of patients with the most frequent finding being angiodysplasia (52.2%). Haemoglobin level was the only variable associated with a positive finding. A significant number of studies had significant findings outside the small bowel (41.8%), overwhelmingly within reach of conventional upper endoscopy (89.3%). Conclusions VCE is a valuable diagnostic modality in patients with IDA. Low haemoglobin was associated with a positive finding on VCE in this group of patients.

scholarly journals A Screening Test for Iron Deficiency Anaemia and Thalassaemia Traits

2015 ◽  
Vol 32 (4) ◽  
pp. 190-193
Author(s):  
Amin Lutful Kabir ◽  
Tashmim Farhana Dipta ◽  
Hajera Khatun ◽  
Mohammad Hafizur Rahman ◽  
Mahfuz Haq ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Predictive Value ◽  
Iron Deficiency Anaemia ◽  
Osmotic Fragility ◽  
Red Cell ◽  
Deficiency Anaemia ◽  
Final Study ◽  
Thalassaemia Trait ◽  
Study Population

Both iron deficiency and thalassaemia trait can present with hypochromic microcytic morphology. Naked eye single tube red cell osmotic fragility (NESTROF) is an inexpensive and simple test which can effectively differentiate iron deficiency anaemia from thalassaemia trait. Our study was an opportunity to observe the role of NESTROF in screening of thalassaemia trait among our study population. Initially NESTROF was carried out in 677 patients (N) population of four groups having both positive and negative NESTORF; for economical issue, auto-analyzer study and haemoglobin electrophoresis were done among only 100 randomly selected subjects, who were finally included in our study as final study population (n). In our study, NESTROF was 94.23% sensitive and its specificity was 92.08%. The predictive value of a positive test was 88.13% and predictive value of a negative test was 96.24%. Our study showed, NESTROF can effectively differentiate iron deficiency anaemia (IDA) from thalassaemia trait but, is not effective in co-existent IDA and thalassaemia.J Bangladesh Coll Phys Surg 2014; 32: 190-193

Diagnostic Yield of Colonoscopy in Patients Referred with Iron Deficiency Anaemia. Do Patients under 50 Years of Age Merit Such Indication?

2007 ◽  
Vol 102 ◽  
pp. S266
Author(s):  
Mahboob Ali ◽  
Linga Devi Thanasekaran ◽  
Abdur Rafeh Khan ◽  
Irfan Maqsood ◽  
Nosheen Khawaja ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Diagnostic Yield ◽  
Deficiency Anaemia

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

Gut ◽  
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.

Tu1341 Low Long Term Predictive Value of Sbce Despite High Diagnostic Yield in Iron Deficiency Anaemia

2012 ◽  
Vol 142 (5) ◽  
pp. S-807
Author(s):  
Grainne Holleran ◽  
Sarah Barry ◽  
Orla Thornton ◽  
Mark Dobson ◽  
Deirdre McNamara
Keyword(s):  
Iron Deficiency ◽  
Predictive Value ◽  
Iron Deficiency Anaemia ◽  
Diagnostic Yield ◽  
Deficiency Anaemia ◽  
High Diagnostic Yield
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