Introduction BSG guidelines provide clear recommendations for the investigation and management of iron deficiency anaemia (IDA). The algorithm lends itself to a ‘one stop’ new patient clinic in secondary care with further follow-up in primary care. We set up a dedicated IDA clinic aiming to streamline patients’ management and reduce unnecessary follow-up visits.
Methods A ‘one stop’ IDA clinic was set up and run by a single gastroenterologist from November 2013. Data was collected prospectively for the first 60 patients referred with IDA (Group A). Patients without confirmed IDA (10, [17%]) were analysed separately. A second group of proven IDA referrals seen in unselected gastroenterology clinics in 2011 was identified (Group B). Rates of clinic follow up were recorded and the two groups compared. Additional data collected included demographics, haemoglobin, MCV, ferritin and other iron indices (Fe/TIBC) as well as radiology and endoscopy reports. Iron deficiency was defined as isolated microcytosis and/or low ferritin.
Results Fifty patients fulfilled diagnostic criteria for IDA in group A (35 female, median age 69.0, range 35–91). Group B comprised 50 IDA patients (28 female, median age 72.0, range 38–83). All patients in Group A were seen by a single, UKconsultant compared to 80% seen by consultants in Group B.
Four patients were diagnosed with colorectal cancers in group A. Two patients were diagnosed with oesophago-gastric tumours and 4 with colorectal cancers in group B. One new diagnosis of coeliac disease was made in each group. Group A contained five females with gynaecological pathology responsible for IDA (1 advanced cervical cancer and 4 menorrhagia).
Despite confirmation of IDA with a low ferritin, 11 (22%) in Group A and 6 (12%) in Group B had undergone additional serum iron/TIBC measurements before referral. Only 3/17 (18%) iron studies were congruent with the ferritin result.
Significantly more patients in Group A (94%) were discharged back to primary care after their initial consultation and investigations compared to Group B (26%, p < 0.0001).
Conclusion A specialist IDA clinic leads to appropriate discharge to primary care virtually eliminating secondary care follow up. Clinical assessment allows identification of a significant proportion of non-IDA referrals requiring alternative management. Measurement of serum iron/TIBC should be discouraged.
Disclosure of Interest None Declared.
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