[Iron deficiency anemia in hospitalized males and postmenopausal females. Diagnostic approach]
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A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
Published on: January 19, 2024
F Sánchez Martínez1, A Vilà Santasuana, R Cid Pañella
1Servicio de Medicina Interna, SCIAS, Hospital de Barcelona.
Insights
Chronic gastrointestinal bleeding is a common cause of iron deficiency anemia. Upper gastrointestinal lesions were most frequent, but colonoscopy is crucial for detecting colorectal cancer.
Area of Science:
- Gastroenterology
- Hematology
- Internal Medicine
Context:
- Chronic bleeding from the gastrointestinal tract is a frequent cause of iron deficiency anemia (IDA) in men and postmenopausal women.
- Patients with IDA often lack overt digestive symptoms, complicating diagnosis.
- Previous studies have focused on specific causes, but a comprehensive diagnostic strategy is needed.
Purpose:
- To identify the most common causes of chronic gastrointestinal bleeding in patients with IDA.
- To propose an effective endoscopic diagnostic strategy for clinical practice.
Summary:
- A study of 66 patients (mean age 73) with IDA found at least one bleeding lesion in 70%.
- Upper gastrointestinal lesions were the most frequent cause (31 patients), followed by lower digestive tract lesions (13 patients).
- Colon cancer was diagnosed in 8 patients, and other gastrointestinal cancers in 1. Minor lesions or no lesions were found in 30% of patients, who improved with iron therapy.
Impact:
- Upper gastrointestinal lesions are the primary cause of IDA due to chronic bleeding.
- Colonoscopy is essential for detecting gastrointestinal cancers, even with apparent upper GI bleeding.
- This study informs diagnostic strategies for IDA, emphasizing the importance of both upper and lower endoscopy.
Unlabelled:
Chronic bleeding from the gastrointestinal tract is assumed to be the most common cause of iron deficiency anemia in men and in postmenopausal women.
Aim:
The aim of this study was to assess the most frequent causes of chronic gastrointestinal bleeding in patients with iron deficiency anemia and to suggest a diagnostic endoscopic strategy that could be useful in clinical practice.
Methods:
We studied 66 patients (48 women and 18 men), with a mean age of 73 who were admitted to our hospital from 1993 to 1996 because of unrelated signs and symptoms. Iron deficiency anemia was detected in a routine laboratory test. Patients had no symptoms of digestive disease. Children, pre-menopausal women and patients with a history of digestive disease of anemia of known origin were excluded. Diagnostic procedures included oral panendoscopy, colonoscopy and, in some cases, contrast radiology. In all patients follow-up was carried out between 3 and 36 months after discharge. Patients were considered to have improved when hemoglobin values were normal, according to standard laboratory values.
Results:
At least one lesion responsible for anemia was found in 46 patients (70%). Of these 46 patients, 31 presented a lesion in the upper digestive tract and 13 presented a lesion in the lower digestive tract. Colon cancer was diagnosed in eight patients and gastrointestinal cancer in one. In the remaining two patients, peptic ulcer and colo-rectal cancer were found simultaneously. A diagnosis of "minor" lesions was made in 15 patients (23%) and in five patients (7%) no lesions were found that could have caused the bleeding. Both groups (minor lesions and undiagnosed patients) improved with iron therapy.
Conclusions:
Upper gastrointestinal lesions were the most frequent cause of iron-deficiency anemia, although colonoscopy is the best procedure for detecting gastrointestinal cancer and should be performed despite evident upper gastrointestinal bleeding.
