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Diagnostics in anaemia of chronic disease in general practice: a real-world retrospective cohort study
Annemarie Schop1, Karlijn Stouten2, Ron van Houten3
1PhD Student, Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Insights
General practitioners investigate most cases of anaemia of chronic disease (ACD). Infection, autoimmune disease, and malignancy are the most common causes, though some cases remain unexplained. Caution is advised with oral iron supplementation in ACD patients.
Area of Science:
- General Practice
- Hematology
- Internal Medicine
Background:
- Anaemia of chronic disease (ACD) is common, yet research on its diagnosis and underlying causes in general practice is limited.
- Understanding the diagnostic approaches and prevalence of ACD etiologies is crucial for effective patient management.
Purpose of the Study:
- To investigate the diagnostic strategies employed by general practitioners (GPs) for patients newly diagnosed with ACD.
- To determine the most frequent underlying causes of ACD in a general practice setting.
Main Methods:
- Retrospective cohort study analyzing electronic medical records of patients diagnosed with ACD.
- ACD defined by laboratory criteria: confirmed anemia, ferritin > 100 μg/l, and decreased iron and/or transferrin.
- Included data from GP and referral hospital records.
Main Results:
- Additional investigations were performed in 77% of 267 analyzed ACD patients.
- Underlying causes were established in 79% of patients, with infection (32%), autoimmune disease (24%), and malignancy (23%) being most common.
- Oral iron supplementation was prescribed to 13% of patients, primarily those with severe anemia or lower ferritin levels.
Conclusions:
- GPs typically conduct further investigations to identify the cause of ACD.
- A small percentage of ACD cases remain undiagnosed.
- Judicious use of oral iron supplementation is recommended for ACD patients.
Background:
Limited research has been performed that focused on the diagnosis of the underlying cause of anaemia of chronic disease (ACD) in general practice or on prevalence data of the underlying causes of ACD in general practice, although this is one of the most common types of anaemia.
Aim:
To clarify the diagnostic strategies of GPs in patients newly diagnosed with ACD and to determine the most common underlying causes.
Design & Setting:
Retrospective cohort study.
Method:
Patients newly diagnosed with ACD were selected based on laboratory criteria. ACD was defined as confirmed anaemia and ferritin levels above 100 μg/l combined with decreased iron and/or reduced transferrin. Additional medical information on patients was obtained from the electronic medical files of the GP and/or the referral hospital.
Results:
Of the 267 analysed patients with ACD, additional investigations were performed in 205 patients (77%); in 31 patients (12%) the cause was apparent at the time of diagnosis, and for 31 patients (12%) no additional investigations were requested. In 210 (79%) of the 267 patients, an underlying cause was established, with infection (n = 68, 32%), autoimmune disease (n = 51, 24%) and malignancy (n = 48, 23%) as the most frequently observed etiologies. In 35 (13%) of the ACD patients, oral iron supplementation was prescribed by the GP. This was mainly done in patients with severe anaemia or less enhanced ferritin levels.
Conclusion:
For most patients with newly diagnosed ACD, the GP undertakes additional investigations to establish underlying causes. However, the cause of ACD remains unknown in a small proportion of patients. The use of oral iron supplementation in these patients requires caution.
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