Evaluation of iron deficiency anaemia in tertiary hospital settings: Room for improvement?

Khadem, G., Scott, I. A. and Klein, K. (2012) Evaluation of iron deficiency anaemia in tertiary hospital settings: Room for improvement?. Internal Medicine Journal, 42 6: 658-664.

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Author Khadem, G.
Scott, I. A.
Klein, K.
Title Evaluation of iron deficiency anaemia in tertiary hospital settings: Room for improvement?
Language of Title eng
Journal name Internal Medicine Journal  (ERA 2012 Listed)    (ERA 2010 Rank B)   Check publisher's open access policy
Language of Journal Name eng
Publication date 2012-06
Sub-type Article
DOI 10.1111/j.1445-5994.2012.02724.x
Volume number 42
Issue number 6
ISSN 1444-0903; 1445-5994
Start page 658
End page 664
Total pages 7
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2013
Language eng
Formatted abstract Background:  Iron deficiency anaemia (IDA) is a marker of occult blood loss from gastrointestinal (GI) lesions and requires thorough GI evaluation.

Aim:  This study aimed to determine frequency and findings of GI endoscopy in patients with IDA attending a tertiary hospital, and associations of endoscopy with patient and clinician-related factors and results of faecal occult blood tests (FOBT).

Methods:  Retrospective audit of 621 subjects identified with definite and probable IDA (serum ferritin ≤15 ug/L and 16–50 µg/L respectively) between 1 January 2006 and 31 December 31 2008. Subjects were analysed as males >18 years and females ≥45 years of age with definite (group A, n= 180) or probable (group B, n= 353) IDA, and females <45 years of age with definite or probable IDA (group C, n= 88).

Results:  Endoscopy of any type was documented in 310 (50%) of patients with oesophagogastroduodenal endoscopy, and colonoscopy rates being significantly higher in group A patients (61% and 56% respectively) than in group B (39%, 37%) and group C (30%, 31%; P≤ 0.01 for all comparisons). Endoscopy rates ranged from 96% of patients seeing gastroenterologists to 31% of those seeing nephrologists. In patients undergoing colonoscopy, cancer and high-risk adenomas were detected in 51 patients (20%), ranging from 27/100 (27%) of group A, 23/130 (18%) of group B and 1/27 (4%) of group C. Lesion prevalence was similar (19–24%) regardless of whether FOBT yielded positive or negative results or had not been performed.

Conclusions:  Almost one in two patients with IDA were not documented as undergoing GI endoscopy. More intense guideline promulgation, improved endoscopy access and ongoing practice audits are required to improve endoscopy rates.
Keyword Iron deficiency
Anaemia
Endoscopy
Hospital
Cancer
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

 
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Created: Wed, 07 Mar 2012, 13:55:57 EST by Kere Klein on behalf of School of Population Health