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. 2020 Sep 10;13(1):20-24.
doi: 10.1136/flgastro-2020-101470. eCollection 2022.

The dedicated iron deficiency anaemia clinic: a 15-year experience

Helen Stone  1 , Orouba Almilaji  1   2 , Christopher John  1 , Carla Smith  1 , Susan L Surgenor  1 , Lachlan Ayres  1 , Elizabeth J Williams  1 , Jonathon Snook  1
Affiliations

The dedicated iron deficiency anaemia clinic: a 15-year experience

Helen Stone et al. Frontline Gastroenterol. .

Abstract

Objective: To report our cumulative experience from a dedicated iron deficiency anaemia (IDA) clinic over the last 15 years-with particular emphasis on referral rate, uptake of investigation, impact on endoscopy services, diagnostic yield of gastrointestinal (GI) investigation and the issue of recurrent IDA.

Method: A series of analyses of a register of 2808 referrals to the Poole IDA clinic between 2004 and 2018.

Results: The study population of 2808 had a sex ratio of 1.9 (female/male ratio) and a median age of 72 years (IQR: 60-79). A rising referral rate over the study period appears to be plateauing at around 2 cases per 1000 population per annum. On the basis of a snapshot audit, investigation of IDA may now account for over 20% of all diagnostic endoscopies.Overall, 86% of cases underwent examination of the upper and lower GI tract. Significant GI pathology was identified in 27% of the investigated cohort. Adenocarcinoma of the upper or lower GI tract was found in 8.3%, the majority in the right colon. The prevalence of recurrent IDA was estimated at 12.4%, and the results of investigation of this subgroup are reported.

Conclusion: Unexplained IDA is common, particularly in those over 60 years, and may be the first indication of underlying GI malignancy in over 8% of cases. Unresolved challenges include accommodating the resulting endoscopy workload, establishing a risk/benefit ratio for investigating those with major comorbidities and the management of recurrent IDA.

Keywords: gastrointestinal cancer; iron deficiency.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Referral numbers over the study period, and number of cancers revealed by gastrointestinal (GI) investigation.
Figure 2
Figure 2
Percentage in each age-band undergoing complete initial gastrointestinal investigation.
Figure 3
Figure 3
The distribution of pathological findings in the major diagnostic categories by age-band.
Figure 4
Figure 4
The percentage of investigated subjects with gastrointestinal (GI) cancer in the upper or lower GI tract by triennium.
See this image and copyright information in PMC

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