1 / 29

Iron deficiency anaemia

Iron deficiency anaemia. Christian Selinger Consultant Gastroenterologist. Talk outline. Talk outline. Definitions Diagnosis History Examination GP tests Investigations Treatment Primary / secondary care interface. Definition. Anaemia characterised by low iron stores Lab results:

noelle-mcdowell
Télécharger la présentation

Iron deficiency anaemia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Iron deficiency anaemia Christian Selinger Consultant Gastroenterologist

  2. Talk outline

  3. Talk outline • Definitions • Diagnosis • History • Examination • GP tests • Investigations • Treatment • Primary / secondary care interface

  4. Definition • Anaemia characterised by low iron stores • Lab results: • Low Hb • MCV low • Ferritin low • Low Transferrin saturation

  5. Case 1 • 68y old man • Rarely comes to surgery • Complaints • Lack of energy • Tired • Saw locum, bloods done – nil else • Hb 105, MCV 76

  6. How to proceed? What would you do?

  7. Case 1 • Ferritin 7 • Referred as STT • Had gastroscopy and colonoscopy • Caecal cancer • Started on CRC pathway • Scans, surgery, etc

  8. Diagnosis • History • Visible blood loss • Upper GI symptoms • Lower GI symptoms • Women: menstrual status • Abdominal examination +/- PR • Bloods • FBC • Ferritin (occ Transferrin saturation) • Coeliac serology

  9. Borderline cases • Iron defiency without anaemia • Less clear: optional non-urgent gastro referral • IDA in menstruating women • Heavy periods: consider OG referral • Normal periods: gastro referral (?urgency)

  10. Referral pathways • No significant GI symptoms • STT colorectal cancer pathway • Significant GI symptoms • Lower or upper GI cancer pathway only • Previously investigated IDA • Non-urgent gastro referral • PP options available

  11. Secondary care investigations • Gastroscopy • Duodenal biopsies • Colonoscopy • Coeliac serology • Done as STT • All will be followed up (timing)

  12. Colonoscopy vs CT • Colonoscopy • Invasive, mobility needed, prep suitability • Consider frailty, comorbidities • CT colonography or “plain” • Better tolerated, no therapy • CTC needs prep

  13. Typical findingsat initial presentation Pengelly et al 2012

  14. Cancer risk at initial presentation • Italian study of IDA • Maybe even higher • 11.6% CRC • 2% upper GI cancer Milano et al 2011

  15. Case 2 • 45 year old female • Background: rheumatoid arthritis • New anaemia • Hb 100, MCV 72, Ferritin 3 • Initial plan?

  16. Case 2 Gastroscopy normal Colonoscopy normal Duodenal biopsy normal Where do we go from here?

  17. Case 2 • 3/12 oral iron • Hb 120, Ferritin 35 • Stopped • 6/12 later • Hb dropped to 98 • SB investigation

  18. What about the small bowel • Small bowel malignancy rare • 2.1 per 100.00 and year • Colorectal cancer 43.4 per 100.00 and year • None found in Pengelly and 5 (2%) in Milano study • SB is a side of benign disease largely

  19. SB radiology • Ba meal and F/T • Reasonably good for tumours, Crohn’s, ulceration • Unable to detect vascular lesion

  20. SB radiology • CT or MRI • Very good for tumours, Crohn’s, ulceration • Unable to detect vascular lesion

  21. SB endoscopy • Pillcam • Good views • Can get stuck • May miss lesions • Enteroscopy • Very invasive • Long procedure • Only for therapy

  22. What do you find in SB? • Meta-analysis of 24 studies (1960 pts) • Overall diagnostic yield of pillcam: 47% • Detailed findings (1194 pts): • Significant selection bias: not unselected group Koulaouzidis et al 2012

  23. What do we miss on first endoscopies? • 5 years after initial normal investigations • CRC 1.3% • Other malignancies: 5.9% • Rest negligible Pengelly et al 2012 • Consider co-morbidities

  24. Approaches • Investigate everything initially • Invasive • Expansive • Finds lesions not clinically relevant • Expectant management • Iron supplementation • Investigation when not sufficient / drops again • Patient friendly & cheaper • Very occ delay in diagnosis

  25. Treatment of “quiescent” SB disease • Vascular lesions • Cauterisation vs iron supplementation alone • Accessibility and number of lesions • Need for transfusions • Inflammation • Depends on other symptoms

  26. Iron, who, when and how? • Oral preparations • Side effects • Esp in GI disease • Colonoscopy • Iv iron • Non-response • Non-tolerance

  27. Who should monitor? • GP • Easier access • More timely • Cheaper • Consultant • Access to diagnostics • Experience with therapeutics

  28. Follow up strategies • Iron “for ever” • Monitor and iron as needed • Investigate until cause found

  29. Questions and Discussion

More Related