The investigation of iron deficiency anemia--a hospital based audit

Iron deficiency anemia (IDA) is associated with an increased incidence of malignancy. Our aim was to audit the management of patients with IDA seen in a teaching hospital gastroenterology unit, and to assess the role of upper and lower gastrointestinal endoscopy as well as mesenteric angiography in improving the diagnostic yield.

A retrospective review of all outpatient letters and in-patient discharge summaries in an 11 month period in 1996 was used to identify anemic patients. All endoscopic and radiological procedures were documented on these patients.

98 cases (46 male) of IDA were identified. Of these, 94% had upper GI endoscopy with a yield for potential bleeding sources of 54% (including 4 malignancies) and 84% had lower GI investigation by colonoscopy or barium enema with a diagnostic yield of 37% (including 3 malignancies and 10 adenomatous polyps). Combined endoscopic and barium examinations provided a positive diagnosis in 69%, and 12.2% had significant co-existent upper and lower GI pathology. Thirty-three patients underwent visceral angiography (27 of who had no positive endoscopic diagnosis). Twenty-seven studies revealed a bleeding source (yield 82%). Overall an underlying diagnosis was made in 92% of patients.

The incidence of significant dual pathology in patients with IDA was high. Investigation of the lower GI tract should be performed in all patients unless a malignancy is found on upper GI endoscopy. Mesenteric angiography has a high diagnostic yield, and is a useful investigation in patients with resistant or transfusion dependent anemia in whom endoscopic or barium studies are normal.