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PTH-012 Five-year review of patients presenting with iron deficiency anaemia
  1. S Pengelly1,
  2. M Fabricius1,
  3. D McMenamin1,
  4. E Wu1,
  5. M Metzner2,
  6. S Lewis2,
  7. K B Hosie1
  1. 1Department of Surgery, Derriford Hospital, Plymouth, UK
  2. 2Department of Gastroenterology, Derriford Hospital, Plymouth, UK

Abstract

Introduction Between 2000 and 2002, 639 consecutive patients referred to the Iron Deficiency Anaemia (IDA) pathway were prospectively collated on a database. We present the 5-year review of outcomes.

Methods 639 patients presenting to the IDA pathway were prospectively entered onto a database. Initial assessment included haematological review, coeliac screen, OGD and colonic imaging. A 5-year review of outcomes was undertaken using patient medical records and hospital laboratory databases.

Results A cause for the IDA had been found initially in 267 (42%) of these patients, with 126 (20%) having a GI luminal tumour; 55 (9%) of these were malignant. 93 (15%) had benign UGI bleeding and 23 (4%) had coeliac disease. Complete medical records were available for 595 (93%) of patients. Of the 373 patients in whom a cause was not initially found, over 5 years 6 (1%) of these were ultimately diagnosed with a GI luminal malignancy and 18 (5%) with a non-luminal or non-GI malignancy. 14 patients (4%) had chronic renal disease, often involving haematuria. 12 (3%) of the anaemias were attributed to gynaecological bleeding. 260 patients never had a cause found and 84% of these had documented resolution of their IDA over a median period of 4 months (range 0–60).

Conclusion Investigation of patients with unexplained IDA consumes a lot of health resources with large numbers of patients never getting a formal diagnosis. This is an effective pathway with a very high yield of tumours: 161 (25%), of which 131 were luminal GI tumours and 30 were non-luminal or non-GI tumours. Where a cause was not found initially, urological and gynaecological problems occurred frequently. In those patients where a cause was never found, either the patient was never anaemic or the anaemia resolved spontaneously.

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