[Iron-deficiency anaemia: a sign that requires an adequate explanation]

Area of Science:

• Gastroenterology
• Oncology
• Internal Medicine

Background:

• Iron-deficiency anaemia (IDA) is a common clinical finding with diverse etiologies.
• In individuals over 50, gastrointestinal bleeding is a primary cause of IDA, especially in the Netherlands.
• IDA necessitates comprehensive investigation to identify the underlying cause.

Observation:

• Three patients aged 58-79 presented with IDA and right-sided colon adenocarcinoma.
• Diagnostic evaluations were suboptimal in all three cases, delaying definitive diagnosis.
• One patient initially received iron supplementation without adequate workup, while another's imaging was insufficient.

Findings:

• Ascending colon carcinoma is a significant cause of IDA in patients over 50, even without upper GI symptoms.
• IDA should be recognized as a critical clinical sign warranting thorough investigation.
• Diagnostic procedures like colonoscopy are essential for detecting neoplasms, ulcers, or angiodysplasia.

Implications:

• Accurate and timely evaluation of IDA is vital to rule out serious conditions like colon cancer.
• Prioritizing the exclusion of right-sided colon cancer is crucial in patients presenting with IDA.
• This underscores the importance of a systematic diagnostic approach for IDA to ensure appropriate patient management and outcomes.