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Sources of gastrointestinal blood loss causing iron-deficiency anemia
Source publication
Iron-deficiency anemia is a common reason for referral to a gastroenterologist. In adult men and postmenopausal women, gastrointestinal tract pathology is often the cause of iron-deficiency anemia, so patients are frequently referred for endoscopic evaluation. Endoscopy may be costly and at times difficult for the patient. Therefore, physicians nee...
Context in source publication
Context 1
... of this dietary reserve, malabsorption leads to IDA only when the malabsorptive disease is at a well advanced stage, with the exception of celiac sprue (discussed later). Table 1 lists the gastrointestinal conditions that have been described to cause IDA. Many of these conditions are common in the general population; thus, it is often unclear, in a specific clinical setting, whether a particular lesion is responsible for the iron loss. ...
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Iron deficiency anemia (IDA) is associated with a number of pathological gastrointestinal conditions other than inflammatory bowel disease, and also with liver disorders. Different factors such as chronic bleeding, malabsorption and inflammation may contribute to IDA. Although patients with symptoms of anemia are frequently referred to gastroentero...
Background Anemia in children and adolescents affects growth
and development. It is a preventable disease, but unfortunately is
often ignored until the symptoms occur. There have been limited
reports on the prevalence of anemia in children and adolescents
in Indonesia, especially from rural areas.
Objective To describe the prevalence of anemia in c...
Citations
... However, the DCGP guideline recommends a colonoscopy and/or gastroscopy in IDA patients aged > 50 years, to exclude a gastrointestinal malignancy. 24 As such malignancies can be detected in 6-15% of IDA patients, [25][26][27][28][29][30] this increase in immediate referrals may increase the probability that a gastrointestinal malignancy is diagnosed. Thereby, this increase in costs will likely enhance rapid initiation of adequate treatment, potentially improving treatment effectiveness. ...
Background
Establishing the underlying cause of anaemia in general practice is a diagnostic challenge. Currently, general practitioners individually determine which laboratory tests to request (routine work-up) in order to diagnose the underlying cause. However, an extensive work-up (consisting of 14 tests) increases the proportion of patients correctly diagnosed. This study investigates the cost-effectiveness of this extensive work-up.
Methods
A decision-analytic model was developed, incorporating all societal costs from the moment a patient presents to a general practitioner with symptoms suggestive of anaemia (aged ≥ 50 years), until the patient was (correctly) diagnosed and treated in primary care, or referred to (and diagnosed in) secondary care. Model inputs were derived from an online survey among general practitioners, expert estimates and published data. The primary outcome measure was expressed as incremental cost per additional patient diagnosed with the correct underlying cause of anaemia in either work-up.
Results
The probability of general practitioners diagnosing the correct underlying cause increased from 49.6% (95% CI: 44.8% to 54.5%) in the routine work-up to 56.0% (95% CI: 51.2% to 60.8%) in the extensive work-up (i.e. +6.4% [95% CI: −0.6% to 13.1%]). Costs are expected to increase slightly from €842/patient (95% CI: €704 to €994) to €845/patient (95% CI: €711 to €994), i.e. +€3/patient (95% CI: €−35 to €40) in the extensive work-up, indicating incremental costs of €43 per additional patient correctly diagnosed.
Conclusions
The extensive laboratory work-up is more effective for diagnosing the underlying cause of anaemia by general practitioners, at a minimal increase in costs. As accompanying benefits in terms of quality of life and reduced productivity losses could not be captured in this analysis, the extensive work-up is likely cost-effective.
... Overall, 7%-47% of cases are idiopathic even after extensive investigation. 3 The two most important disorders to be differentiated from iron defi ciency are the anaemia of chronic infl ammation (both the serum iron and TIBC will be low, with a normal or increased level of serum ferritin) and thalassaemia (presence of target cells and tear-drop shaped red cells on PBS, normal to increased serum ferritin levels and a normal to increased red blood cell count). The annual incidence of multiple myeloma in the USA is approximately 4-5 per 100 000. ...
A 58-year-old man with long standing unexplained iron deficiency anaemia presented with severe hypercalcaemia and was subsequently diagnosed with multiple myeloma. Anaemia in multiple myeloma is usually normochromic and normocytic.1 To our knowledge, there are no reported cases in the English literature of true iron deficiency associated with multiple myeloma. Our case highlights the importance of pursuing the aetiology of iron deficiency, especially in a middle aged male. It also reinforces the fact that severe hypercalcaemia usually has a malignant aetiology.
... Iron deficiency anemia (IDA) is the most common form of anemia worldwide [1]. It is a common reason for referral to a gastroenterologist [2]. Iron deficiency is the most common cause of hypochromic, microcytic anemia worldwide. ...
... is the most prevalent type of anemia worldwide [7]. In the 2 females reported there was an evidence of severe iron-deficiency anemia with a serum ferritin level of 2–3 ng/mL. ...
Pagophagia, or the practice of consuming ice, is a particular expression of the more general phenomenon of pica. Pagophagia is a complex behavioral phenomenon arising from the interplay of biochemical, hematological, psychological, and cultural factors. This compulsive dietary aberration is observed in many children and pregnant women worldwide. The authors report 3 cases of severe iron deficiency anemia with a serum ferritin level of 2-3 ng/mL, in which the patients were consuming 2 trays and many bags of ice per day. Following treatment with iron therapy, pagophagia spontaneously resolved within 2 weeks. It is a commonly missed problem. Pediatricians should be alert to this phenomena and its association with iron-deficiency anemia.
... Clinical symptoms seemed to help little in distinguishing malignancy, as a previous review article has shown [14]. For example, changes in bowel movement, usually thought to be a suspicious sign of carcinoma of colon, occurred more frequently in the benign tumor group (Table III) than in others, although the occurrence rate in the malignant group and the nontumor group (Group C) was similar (12.5% vs. 14.3%, ...
Gastrointestinal (GI) tract malignancy is one of the important causes of chronic iron deficiency anemia (IDA). The present study was designed to find out the prevalence and the predictive risk factors of malignancy in the IDA patients. We performed a prospective study in 148 patients with chronic IDA. A series of examinations to explore the GI tract were performed either by radiology and/or endoscopy. A Tc-RBC GI bleeding study was also performed, and prevalence and risk factors of malignancy were calculated. Totally 148 patients were enrolled, with mean age 66.2 years; 88 were male. Eighteen patients (12.2%) were found to have malignant tumors. Ten (6.8%) had benign tumors, and 96 (64.9%) had other benign conditions. No lesions could be detected in 24 patients (16.2%). Clinical symptoms and presence of fecal occult blood could not predict malignancy or any GI lesions. Multivariate logistic regression analysis showed serum ferritin < or =10 microg/L, LDH >250 U/L, and aging as the risk factors of malignancy in the IDA patients (P = 0.003, 0.002, and 0.027; and OR = 7.614, 8.955, and 1.062, respectively). An IDA patient with both serum ferritin < or =10 microg/L and LDH >250 U/L ran a 74.33-times higher risk of malignancy than the patient without (95% CI: 7.115-776.479). Malignancy was an important cause of IDA. High LDH, low serum ferritin, and aging were the risk factors of malignancy in the IDA patients.
Iron deficiency anemia and occult and/or obscure gastrointestinal (GI) bleeding are common reasons for referral to Gastroenterologists. This chapter describes the evaluation of GI causes of anemia and occult/obscure bleeding. After a thorough history and physical examination, endoscopy is the cornerstone of the investigation. Over half of the cases of obscure GI bleeding are within reach of a colonoscope or push enteroscope. Capsule endoscopy and the newer modalities, double- and single-balloon enteroscopy, can evaluate the remainder of the small intestine.
The manifest or chronic bleeding are the most common causes of iron deficiency anemia. We studied 596 patients (323 men and 273 women), with a mean age 61±10.67 godina who were admitted to our hospital in 2002 beceause of iron deficinecy anemia caused by manifest or chronic bleeding. A mean hemoglobin was 88±9.8 g /L, a mean serum iron was 6.3±14.3 μmol/L and UIBC 61±12.4 μmol/L. The causes of iron deficiency anemia were: peptic ulcerations in 28.9% patients, varices in 15.1% patients, inflammatory bowel diseases in 14.1% bolesnika, colonic cancers in 8.5% patients, gastric cancer in 5.6 % patients, esophageal cancer in 1% patients, erosive gastritis in 6.2% patients, hiatal hernia in 4.7% patients, polyps in 7.3% patients, diverticulosis in 5.3% patients, hemorrhoids in 0.5% patients and other causes in 2.8 % patients. In the gastroenterology iron deficiency anemia is result of manifest or chronic bleeding from the gastrointestinal lesions.
A review is carried out on the changes with age (increase) in iron nutritional status and its influence on health status. With this aim the major characteristics of iron metabolism are described and studies on this subject in adults and aged people are reviewed. In aged people ferropenic (iron deficient anaemia) prevalence is low, but not negligible. Recent studies show a trend to an increase in iron stores with age, fact that constitutes a potential risk for health, due to the ability of iron to generate free radicals and the relationship botween those radicals with alterations such as cancer, atherosclerosis, inflammatory processes, aging, coronary, infectious and neurodegenerative diseases. Given that in developed countries adults and aged people are population groups on risk of anaemia or iron overload, the programs of prevention or control proposed for people in general in different studies, should be adapted to individual conditions and circumstances in order to not underestimate the risk in people in risk.
Objective
Valid data on anemia caused by bleeding are needed for epidemiological research and monitoring health care. The Danish National Registry of Patients (DNRP) is a nationwide medical database with information on all Danish residents’ hospital history. We aimed to assess the positive predictive value (PPV) of the diagnostic coding of anemia caused by bleeding in the DNRP.
Methods
In the DNRP, we identified all patients with International Classification of Disease, 10th edition codes for anemia caused by bleeding (acute: D50.0; chronic: D62.6) at three Danish hospitals from 2000 through 2009. For these patients we computed the PPV using hemoglobin level data, from Aarhus University laboratory database, as reference standard. Anemia was defined by a hemoglobin level less than 7.0 mmol/L for women and less than 8.0 mmol/L for men.
Results
We identified 3391 patients in the DNRP with a diagnosis of anemia caused by bleeding. The overall PPV was 95.4% (95% confidence interval [CI]: 94.6%–96.0%). The PPV was 97.6% (95% CI: 96.6%–98.3%) for men and 94.0% (95% CI: 92.9%–94.9%) for women, and the PPV increased with age at diagnosis. The PPV varied according to type of discharging departments, from 89.2% (95% CI: 83.4%–93.4%) in gynecology to 96.8% (95% CI: 94.9%–98.2%) in surgery, and was lower for outpatients compared with inpatients.
Conclusion
We found a high PPV of the coding for anemia caused by bleeding in the DNRP. The registry is a valid source of data on anemia caused by bleeding for various purposes including research and monitoring health care.
