Introduction Iron-deficiency anaemia in adults is a common cause of referral to gastroenterologists (4–13% of referrals). NICE guidelines, UK provides clear recommendations regarding upper and lower gastrointestinal investigations for such patients including coeliac and urine screening. The aim of this audit is to conduct a snapshot review of anaemic patients seen in gastroenterology anaemia clinic conducted by specialist nurses with consultant gastroenterologists input in a DGH to assess adherence to the NICE guidelines and to highlight changes in clinical practise that may be required, with implications for service development.
Methods Retrospective study involving 90 new patients referred predominantly from primary health care (92%) between July to September 2012.Of the 90 patients referred, 84 patients in the age range of 30–90 attended the clinic of which 53% were females.
Results The mean HB was 10.8 & 80% of the patients had ferritin level of less than 45. Of them 14 patients (16%), all referred from primary care were normocytic with no evidence of iron deficiency and did not require GI investigations. All iron deficient patients underwent coeliac screening (100%) but only 62% had evidence of urine screening for blood loss. 82% of the patients finished their investigations within 12 weeks from their first clinic appointment.62 patients (88%) underwent upper GI endoscopy and the rest were either unfit or declined endoscopies. Lower gastrointestinal tract was investigated in 75% of patients endoscopically or by CT colon (25%) and 22% underwent CT abdomen. An upper GI cause for anaemia was found in 30 patients (42%) and 20% had lower GI cause with gastric and colonic cancer diagnosed in one patient each. 5 patients (22%) with resistant anaemia are awaiting small bowel investigations whilst the rest (21%) are being monitored on iron therapy. Interestingly one patient each with lung, renal and bone malignancy were diagnosed and one with carcinoid after undergoing investigations in this clinic.
Development of a referral pro-forma to anaemia clinic with clear criteria to establish iron deficiency has been recommended to ensure appropriate referrals and to enable effective use of resources. The importance of regular urine screening and its inclusion in the referral pro-forma to assess renal causes for anaemia is being highlighted.
Though the detection rate of gastrointestinal malignancy in anaemia clinic during the audit period was low, this rate can be periodically variable. The audit found that majority of patients with iron deficiency anaemia underwent upper and lower GI investigations in compliance with NICE guidelines within a satisfactory time scale and investigations not only led to early detection of GI cancers but also other malignancies.
Disclosure of Interest None Declared.
NICE Guidelines UK for Iron deficiency anaemia.
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