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Iron Deficiency Anaemia Patients Not Adequately Investigated: Presented at EHA

By Ian Mason
Special to DG News

FLORENCE, ITALY -- June 10, 2002 -- Gastric and bowel cancers are not being detected early because iron deficiency anaemia is significantly under investigated, according to a large community based study

Dr Elizabeth Logan and colleagues, Kings Mill Hospital, Nottinghamshire, England, reported the findings from the British study here Sunday at the 7^th Meeting of the European Hematology Association, Florence, Italy.

The researchers examined the presentation, treatment, investigation and clinical outcome of men over 20 years and women over 50 years presenting with acute iron deficiency anaemia (IDA).

Despite British Society of Gastroenterology guidelines suggesting that 90 percent of patients with IDA should be investigated to find a cause for their anaemia, Dr Logan's study found that the cause of the patients' anaemia was not investigated in almost one third of cases.

In the study 154 men and 277 were identified from the haematology computers of two district general hospitals. Patient follow up was documented over 12 months. In those without a definitive diagnosis, outcomes were reviewed over a further two to three years.

During the first three months, 225 (52 percent) patients were managed by their general practitioner alone, 175 (41 percent) by shared care, and 31 (7 percent) by urgent admission to hospital. A total of 365 (85 percent) patients received a prescription for oral iron; only 144 (33 percent) had their blood count checked within six weeks and 255 (59 percent) had documented evidence of normal haemoglobin within 12 months.

Gastrointestinal (GI) investigation was conducted in 184 (43 percent) patients with a diagnosis of anemia; a further 105 (24 percent) were unfit, refused or died before investigations could take place; 126 (30 percent) were not offered any investigations although they appeared to be fit enough to undergo testing.

Adequate management was more likely with increasing severity of anaemia (p=0.03), upper GI symptoms (p=0.002) and older age adjusted for comorbidity (p=0.007). Twelve months later, 128 (30 percent) had a definitive diagnosis; nine of these patients had upper GI cancers and 32 had colorectal tumours.

The extended follow-up of 231 patients who were still alive but had no confirmed diagnosis showed that 113 (49 percent) remained anaemic. Two gastric cancers and five bowel cancers were found in the 43 patients who had new GI investigations. Two colorectal cancers had not been picked up on earlier barium enemas.

Of 431 patients, 37 (9 percent) had bowel cancer of which 24 were diagnosed within three months, but 13 presented later, 150 (34 percent) had non malignant GI diseases and 166 (38 percent) had no diagnosis at all. A total of 119 patients died, 23 from GI cancers.

"This large community based study showed significant under-investigation and potential morbidity associated with iron deficiency anaemia in the UK. Although it is known that some patients will not have an identifiable cause, an underlying diagnosis was not sought in many of our patients who were otherwise fit [to undergo testing]," Dr Logan reported.

"Unlike other studies of IDA, we show that nearly a quarter of patients presenting with IDA in the community will not be suitable for further investigations. Better monitoring of the response to iron therapy might decrease morbidity and indicate those patients needing further investigation," she added.

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