Introduction Anaemia is common and new NICE guidelines (NG12) for suspected colorectal cancer (CRC) broaden the age and type of anaemia qualifying for urgent two week wait (2 WW) referral. Further, NICE now recommend iron therapy (including intravenous iron) for anaemia prior to surgery. Our study examines how anaemia in 2 WW referrals is related to outcome and the potential for iron therapy as treatment.
Methods Retrospective review of 1000 consecutive patients from 01/12/2014 to 13/07/2015 referred for suspected CRC. Anaemia was defined by WHO (<120g/L women, <130 g/L men), Iron deficiency was defined by BSG (<50ug/L in men and women in presence of inflammatory disease). Data on demographics, referral haemoglobin, MCV, ferritin, referral criteria, investigations and outcome were recorded.
Results 202/1000 (20.2%) had no haemoglobin at time of referral. 305/798 (38.2%) of patients were anaemic at the time of referral. Only 101/305 (33.1%) had been referred for anaemia and 204/305 (66.8%) for other symptoms. 173/305 (56.7%) had a ferritin recorded. Of 249 anaemic patients who completed investigations 40 (16.1%) had CRC detected. Anaemia was associated with detection of cancer (p < 0.05). If anaemic on referral patients were four and a half times more likely to be diagnosed with CRC (OR4.5 95%CI 2.54–8.11 p =< 0.001). However, low ferritin was not associated with cancer detection (OR1.17 95%CI 0.61–2.27 p = 0.636). 113/305 (37.0%) patients would be suitable for iron therapy and a further 132/305 (43.3%) patients may benefit from assessment of ferritin and subsequent iron therapy if low.
Conclusion Anaemia (but not iron deficiency) is associated with CRC detection. About half of patients have no recorded ferritin on referral despite anaemia, but identification of iron deficiency is important as it indicates those patients that would likely benefit from iron therapy in anaemia. Nottingham Colorectal Service historically has not insisted on checking for iron deficiency in our 2 WW referral pathway, these results vindicates this approach and are consistent with new NICE guidance. The introduction of faecal occult blood testing in anaemia as per NICE guidance may help to identify those most likely to benefit from investigations.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.