The investigation of iron deficiency anemia--a hospital based audit.

BACKGROUND/AIMS: Iron deficiency anemia (IDA) is associated with an increased incidence of malignancy. Our aim was to audit the management of patients with IDA seen in a teaching hospital gastroenterology unit, and to assess the role of upper and lower gastrointestinal endoscopy as well as mesenteric angiography in improving the diagnostic yield.
METHODOLOGY: A retrospective review of all outpatient letters and in-patient discharge summaries in an 11 month period in 1996 was used to identify anemic patients. All endoscopic and radiological procedures were documented on these patients.
RESULTS: 98 cases (46 male) of IDA were identified. Of these, 94% had upper GI endoscopy with a yield for potential bleeding sources of 54% (including 4 malignancies) and 84% had lower GI investigation by colonoscopy or barium enema with a diagnostic yield of 37% (including 3 malignancies and 10 adenomatous polyps). Combined endoscopic and barium examinations provided a positive diagnosis in 69%, and 12.2% had significant co-existent upper and lower GI pathology. Thirty-three patients underwent visceral angiography (27 of who had no positive endoscopic diagnosis). Twenty-seven studies revealed a bleeding source (yield 82%). Overall an underlying diagnosis was made in 92% of patients.
CONCLUSIONS: The incidence of significant dual pathology in patients with IDA was high. Investigation of the lower GI tract should be performed in all patients unless a malignancy is found on upper GI endoscopy. Mesenteric angiography has a high diagnostic yield, and is a useful investigation in patients with resistant or transfusion dependent anemia in whom endoscopic or barium studies are normal.