Clinical studyGastrointestinal causes of refractory iron deficiency anemia in patients without gastrointestinal symptoms☆
Section snippets
Patients
From November 1998 to September 1999, 1202 consecutive outpatients were referred by their primary care physician to the University Hematology Department for consultation. Those with iron deficiency anemia, defined as a hemoglobin concentration less than 14 g/dL for men and less than 12 g/dL for women, a mean corpuscular volume less than 80 fL, and a ferritin level less than 30 μg/L were considered for the study (18). These 668 patients (581 women [87%]; median age, 33 years; range, 21 to 94
Evaluation of patients
All patients underwent gastroscopy with routine antral (n = 3 per patient), body (n = 3), and duodenal (n = 2) biopsies. Additional biopsies were taken from suspicious lesions. Sixty-three patients underwent colonoscopy. The cecum was reached in all patients. During colonoscopy, biopsies were taken from polyps or other suspect lesions. The 8 patients who refused colonoscopy were evaluated with a double-contrast barium enema.
Definitions
Several findings were considered possible causes of blood loss in the
Results
A total of 71 patients underwent a complete evaluation within 7 days (Table 2). All patients had symptoms of iron deficiency anemia (eg, fatigue, dyspnea). None had previously sought medical attention or used medications for gastrointestinal complaints. All but 5 patients had been treated previously with oral iron therapy by their primary care physicians without resolution of anemia. Only 24 (34%) of the patients had previously undergone fecal occult blood testing, which was positive in 9
Discussion
In a sample of consecutive patients referred to a hematology department for iron deficiency anemia, in whom obvious or potential causes of blood loss or other diseases able to cause iron deficiency anemia were excluded, at least one gastrointestinal finding likely to cause iron deficiency anemia was detected in 85% of cases.
The higher yield of our results, compared with studies that considered only diseases that were associated with gastrointestinal bleeding 2, 27, 28, 29, 30, may have been the
Acknowledgements
We thank Mrs. Amelia Pasquali for her technical assistance and Mrs. Annette Pickford for her revision of the English language and style.
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Supported by interuniversity cofinanced program 9906218982 (1999) from the Italian Ministry for University and Scientific and Technological Research (MURST), by a grant from Ministero Sanità (Ricerca Finalizzata d.lgs. 229/99), Rome, Italy, and by Fondazione Italiana per le Malattie Digestive (FIMAD).