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.

Iron Deficiency Anaemia-A Prospective Study

1979 ◽  
Vol 9 (4) ◽  
pp. 402-407 ◽  
Author(s):  
P. Kerlin ◽  
R. Reiner ◽  
M. Daviesr ◽  
R. E. Sage ◽  
A. Kerr Grant
Keyword(s):  
Iron Deficiency ◽  
Prospective Study ◽  
Iron Deficiency Anaemia ◽  
Deficiency Anaemia ◽  
A Prospective Study

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.

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.

scholarly journals Intravenous Iron Treatment in Pregnancy: Ferric Carboxymaltose for Correction of Iron Deficiency Anaemia

2017 ◽  
Vol 12 (2) ◽  
pp. 54-57
Author(s):  
Dilruba Zeba ◽  
Parvin Akter Khanam ◽  
Mansur Ahamed ◽  
Md Abul Khair
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anaemia ◽  
Intravenous Iron ◽  
Adverse Outcomes ◽  
Ferric Carboxymaltose ◽  
Childbearing Age ◽  
Deficiency Anaemia ◽  
New Treatment ◽  
A Prospective Study

Iron deficiency is the most common nutritional deficiency state of women in childbearing age. Peri-partum iron deficiency anaemia (IDA) is associated with significant maternal, fetal and infant morbidity. An effective management is needed to prevent adverse outcomes. Current options for treatment are limited; these include oral iron supplements, which are usually ineffective and poorly tolerated, and whole blood transfusion, which carries an inherent risk, should be avoided during pregnancy. Intravenous ferric carboxymaltose is a new treatment option and it is better tolerated with a good result. The study was designed to assess the safety and efficacy of intravenous ferric carboxymaltose for correction of IDA in pregnant women in third trimester. It was a prospective study; 260 anaemic pregnant women received Injection ferric carboxymaltose, as a total dose of 500-1000 mg between 28 to 36 weeks of pregnancy. Safety was assessed by analyzing adverse drug reactions. Ferric carboxy maltose significantly increased Hb level (p<0.001) in all women in this study group. Increased Hb value was observed 3-4 weeks after infusion. None of the women felt worse. No serious adverse effects were found and minor side effects occurred in 34(13%) patients.Our study revealed that the Hb level increased significantly, was well tolerated and without significant side effects.Faridpur Med. Coll. J. Jul 2017;12(2): 54-57

scholarly journals Lanthanum phosphate binder-induced iron deficiency anaemia

2019 ◽  
Vol 12 (3) ◽  
pp. e226157 ◽  
Author(s):  
Christina Awad ◽  
Karin Gilkison ◽  
Erwin Shaw
Keyword(s):  
Iron Deficiency ◽  
Phosphate Binder ◽  
Iron Deficiency Anaemia ◽  
Case Reports ◽  
Mucosal Injury ◽  
Phosphate Binders ◽  
Gi Bleeding ◽  
Gi Tract ◽  
Deficiency Anaemia ◽  
Lanthanum Phosphate

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.

scholarly journals The effect of iron-deficiency anaemia on two indices of nutritional status, prealbumin and transferrin

1980 ◽  
Vol 43 (2) ◽  
pp. 375-379 ◽  
Author(s):  
F. Delpeuch ◽  
A. Cornu ◽  
P. Chevalier
Keyword(s):  
Iron Deficiency ◽  
Nutritional Status ◽  
Iron Deficiency Anaemia ◽  
Haemoglobin Concentration ◽  
Significant Negative Correlation ◽  
Deficiency Anaemia ◽  
Percentage Saturation ◽  
Blood Haemoglobin ◽  
Two Indices ◽  
Children Under 5

1. Serum prealbumin, transferrin and iron concentrations were measured in ninety-two north Cameroonian children under 5 years of age. The results were grouped according to the blood haemoglobin concentration range in order to show the interactions of anaemia with prealbumin and transferrin concentrations.2. Transferrin concentration showed a significant negative correlation with serum Fe and percentage saturation of transferrin values. Prealbumin concentration showed a significant direct correlation with haemoglobin but did not correlate with either serum Fe or percentage saturation of transferrin.3. It is concluded that in regions where Fe-deficiency anaemia is endemic transferrin concentration may be of little value in determining nutritional status. On the contrary, prealbumin seems to be more useful.

Incidence of iron-deficiency anaemia in infants in a prospective study in Jordan

2000 ◽  
Vol 64 (4) ◽  
pp. 231-236 ◽  
Author(s):  
Julia Kilbride ◽  
Terry G. Baker ◽  
Liakat A. Parapia ◽  
Sami A. Khoury
Keyword(s):  
Iron Deficiency ◽  
Prospective Study ◽  
Iron Deficiency Anaemia ◽  
Deficiency Anaemia ◽  
A Prospective Study
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