Introduction Iron deficiency anaemia (IDA) is a common mode of presentation of GI disease, with 50% of symptomatic individuals having underlying GI pathology of whom a third have evidence of an underlying neoplastic process.1 The management of IDA is frequently haphazard with a myriad of referral routes and consequently random and sometimes inappropriate investigations, often with significant delays.2
Methods In 2005, following a retrospective audit which demonstrated our existing service to be suboptimal, we established a nurse-led IDA clinic to streamline, rationalise and accelerate the appropriate investigation and management of patients with asymptomatic (ie, without any GI symptoms) but proven IDA. Subsequently we prospectively collected data on all patients seen by this service.
Results To date we have seen 435 patients, with a complete data set being available in 347. 329 were investigated with bi-directional endoscopy (16 declined and two were unfit for investigation). There were 130 men and 217 women, including a proportion of pre-menopausal women predominantly over the age of 40. The median age was 75 years (IQR 62-82 years). 148 patients had underlying pathology (45%), with 50 of these (34%) having an underlying neoplastic process (see Abstract 088). Furthermore, the time from assessment of IDA to investigation reduced from a median of 51 days (IQR 34–86 days) before the introduction of our nurse-led clinic, to a median of 16 days (IQR 13–24 days). However, in some patients there remained a significant delay from diagnosis of anaemia to confirmation of iron deficiency and onward referral to secondary care.
Conclusion Our nurse led IDA service has optimised the management of patients referred with asymptomatic IDA. Interestingly, our findings in this asymptomatic cohort are consistent with the literature and promote the ideal that IDA should always be investigated in a timely fashion in line with the National Cancer Targets.
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