Long-term outcomes in patients newly diagnosed with iron deficiency anaemia in general practice: a retrospective cohort study

Abstract

ObjectivesTo describe all iron deficiency anaemia (IDA)–related causes during follow-up of patients newly diagnosed with IDA and to assess whether a delayed colorectal cancer (CRC) diagnosis influences survival.Design and settingRetrospective cohort study of patients from general practices in the Dordrecht area, the Netherlands.ParticipantsMen and women aged ≥50 years with a new diagnosis of IDA (ie, no anaemia 2 years previously).MethodFrom February 2007 to February 2018, all relevant data were collected from the files of the referral hospital. Early IDA-related cause was defined as established within 18 weeks after IDA diagnosis. Cox proportional-hazards regression was used to analyse survival of patients with CRC diagnosis.Results587 patients with IDA were included with a median follow-up of 4.6 years. Early and late IDA-related causes could be established in 32% and 8% of patients, respectively. Early and late CRC was found in 8% and 2% of patients, respectively, and were located mainly right sided. After adjustment for age, gender and TNM classification, mortality risk was lower in patients with IDA with early CRC diagnosis, but not significantly (HR 0.30, 95% CI 0.09 to 1.02).ConclusionEven with extended follow-up, the cause of IDA remains elusive in the majority of patients with IDA in general practice. However, patients with IDA are at increased risk for in particular right-sided CRC and a late diagnosis of CRC appears to have a detrimental effect on survival in patients with IDA.

Circulating insulin-like growth factor-I and risk of 25 common conditions: outcome-wide analyses in the UK Biobank Study

“…[39][40][41][42] IGF-I might play an important role in erythropoiesis, 43 suggesting that the observed inverse association is plausible. However, iron deficiency anaemia might have a longer lag time from disease onset or initial diagnosis to hospital admission, 44 therefore reverse causality cannot be ruled out and longer follow-up is needed.…”

A population-based study on time trends of hemoglobin in primary care comparing prediagnostic colorectal cancer patients vs age- and sex-matched controls

“…For iron deficiency anemia (IDA) specifically, PPVs for CRC are estimated to be in the range of 3-10%, and for male patients exclusively even up to 18% [4,6,19]. But studies on the management of IDA in primary care report only a limited proportion of patients, in the range of 30-55%, are referred for early endoscopic evaluation [19][20][21][22]. Male patients and patients with more severe laboratory findings seem to be more likely to be referred for investigation [19,22].…”

“…But studies on the management of IDA in primary care report only a limited proportion of patients, in the range of 30-55%, are referred for early endoscopic evaluation [19][20][21][22]. Male patients and patients with more severe laboratory findings seem to be more likely to be referred for investigation [19,22]. On the other hand, no explanation or IDA-related cause will be found even after long-term follow-up for many patients, and even up to 60% of patients with IDA in primary care [22].…”

“…Male patients and patients with more severe laboratory findings seem to be more likely to be referred for investigation [19,22]. On the other hand, no explanation or IDA-related cause will be found even after long-term follow-up for many patients, and even up to 60% of patients with IDA in primary care [22]. It illustrates the complexity of clinical decision making.…”

Diagnosis and Management of Autoimmune Hemolytic Anemia in Patients with Liver and Bowel Disorders

“…Iron deficiency anemia often originates from chronic gastrointestinal blood loss [ 22 ]. Therefore, patients with microcytic anemia, low levels of ferritin, and transferrin saturation should be investigated for occult blood loss [ 23 , 24 , 25 , 26 , 27 ]. The use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) should be investigated in the clinical history [ 28 , 29 ].…”