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.