British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults

Abstract

Iron deficiency anaemia (IDA) is a major cause of morbidity and burden of disease worldwide. It can generally be diagnosed by blood testing and remedied by iron replacement therapy (IRT) using the oral or intravenous route. The many causes of iron deficiency include poor dietary intake and malabsorption of dietary iron, as well as a number of significant gastrointestinal (GI) pathologies. Because blood is iron-rich it can result from chronic blood loss, and this is a common mechanism underlying the development of IDA-for example, as a consequence of menstrual or GI blood loss.Approximately a third of men and postmenopausal women presenting with IDA have an underlying pathological abnormality, most commonly in the GI tract. Therefore optimal management of IDA requires IRT in combination with appropriate investigation to establish the underlying cause. Unexplained IDA in all at-risk individuals is an accepted indication for fast-track secondary care referral in the UK because GI malignancies can present in this way, often in the absence of specific symptoms. Bidirectional GI endoscopy is the standard diagnostic approach to examination of the upper and lower GI tract, though radiological scanning is an alternative in some situations for assessing the large bowel. In recurrent or refractory IDA, wireless capsule endoscopy plays an important role in assessment of the small bowel.IDA may present in primary care or across a range of specialties in secondary care, and because of this and the insidious nature of the condition it has not always been optimally managed despite the considerable burden of disease- with investigation sometimes being inappropriate, incorrectly timed or incomplete, and the role of IRT for symptom relief neglected. It is therefore important that contemporary guidelines for the management of IDA are available to all clinicians. This document is a revision of previous British Society of Gastroenterology guidelines, updated in the light of subsequent evidence and developments.

Keywords: anaemia; iron deficiency.

Figure 1

Algorithm for the diagnosis of iron deficiency anaemia. ACD, anaemia of chronic disease; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; Hb, haemoglobin; IRT, iron replacement therapy.

Figure 2

Algorithm for the management of IDA. Section reference key: 1—diagnosis, 2—treatment, 3—clinical assessment, 4—coeliac disease, 5—further evaluation. IDA, iron deficiency anaemia; IRT, iron replacement therapy; OGD, oesophago-gastroduodenoscopy.

Figure 3

Overview of treatment algorithm for IDA. IDA, iron deficiency anaemia; IRT, iron replacement therapy.