Prospective evaluation of a clinical guideline for the diagnosis and management of iron deficiency anemia

Ioannou, George N.; Scott, Kevin; Spector, J. Gershon; Rockey, Don C.

doi:10.1016/s0016-5085(08)82012-4

Cited by 4 publications

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“…Patients with hematochezia were included to ensure that patients with brisk UGI bleeding were included; patients subsequently found to have gastrointestinal (GI) bleeding from the small bowel or colon were excluded. Occult UGI bleeding was considered to have occurred in the setting of iron deficiency anemia,11 with or without positive hemoccult testing, along with evidence of a UGI lesion on endoscopy. Exclusion criteria included patients with GI bleeding from the small bowel or colon, patients who developed bleeding during hospitalization, patients who lacked transfusion with RBCs during admission, patients who had massive exsanguination, patients who had prior or unknown resuscitation before arrival to our institution, patients who were thought to require blood transfusion due to potential demand ischemia (see further), and patients who did not undergo endoscopy.…”

Section: Methodsmentioning

confidence: 99%

Blood Transfusion Practices in Upper Gastrointestinal Bleeding: Response to a Landmark Study

Wilhoit

Holman

2020

Journal of Investigative Medicine

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ObjectiveLack of clear evidence in red blood cell (RBC) transfusion during gastrointestinal bleeding has led to varied recommendations over the years. However, studies in broad areas of medicine have provided evidence about appropriate RBC transfusion thresholds, and a ‘landmark’ study published in 2013 provided evidence in patients with upper gastrointestinal (UGI) bleeding. We hypothesized that the response to the evidence would lead to improved RBC transfusion practice. Our aim was to determine the response in RBC transfusion practices at our institution.DesignWe examined RBC transfusion practices in patients with UGI bleeding who presented to the Medical University of South Carolina from January 2010 through December 2013. We abstracted extensive clinical data including demographic, medical history (comorbidities), medications, physical examination findings, laboratory data, endoscopic data, and RBC transfusion practices. We considered appropriate RBC transfusion to have occurred when performed for a hemoglobin level of <70 g/L.Results270 patients hospitalized with UGI bleeding had 606 RBC transfusions; 355 transfusions in 107 patients were appropriate, and 251 transfusions in 163 were inappropriate. In 2010, 2011, and 2012, the rates of appropriate RBC transfusions were 61/124 (49%), 92/172 (53%), and 84/142 (59%), respectively. There was a statistically significant difference in appropriate transfusions in 2013 (118/168 (70%)) compared with 2012 (84/142 (59%), p=0.003), as well as during 2010–2012 (237/438 (54%), p≤0.003).ConclusionsThe data suggest that there was an improvement in RBC transfusion practices after a landmark study. However, the data also highlight that RBC transfusion practices in UGI bleeding remain imperfect.

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Section: Methodsmentioning

confidence: 99%

Blood Transfusion Practices in Upper Gastrointestinal Bleeding: Response to a Landmark Study

Wilhoit

Holman

2020

Journal of Investigative Medicine

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“…Postavljena dijagnoza deficita Fe bez manifestne anemije odnosno sideropenijske anemije nije jedina zavr{na dijagnoza. Ispitivanje se dalje mora usmeriti na utvrdjivanje uzroka deficita Fe i anemije, jer se u protivnom mo'e prevideti ozbiljna bolest 8,15,24 . Naj~e{}i uzrok deficita Fe su hroni~na krvarenja u toku fiziolo{kog menstrualnog ciklusa i okultna krvarenja iz gastrointestinalnog trakta.…”

Section: Klini~ki Zna~ajunclassified

“…Naj~e{}i uzrok deficita Fe su hroni~na krvarenja u toku fiziolo{kog menstrualnog ciklusa i okultna krvarenja iz gastrointestinalnog trakta. Kod 'ena, sideropenijska anemija kao posledica hroni~nog gubitka gvo'dja je naj~e{}a u reproduktivnoj dobi zbog menstrualnih gubitaka i trudno}e. Medju ostalom populacijom, posebno kod mu{karaca starijih od 50 godina i 'ena u menopauzi, hroni~no okultno gastrointestinalno krvarenje je vode}i uzrok sideropenijske anemije 24 . Koli~ina krvi koja se normalno gubi iz gastrointestinalnog trakta iznosi 0,5 -1,5mL/dan, a uobi~ajeni gubitak Fe iznosi oko 1mg.…”

Section: Klini~ki Zna~ajunclassified

“…U slu~aju simptomatske sideropenijske anemije (posebno kod mu{karca svih 'ivotnih doba i 'ena u menopauzi, gubitka telesne mase, pozitivne porodi~ne anamneze, te{ke anemije) bolesnike treba ispitati endoskopski, osim u sluajevima kada anamneza i fizikalni pregled jasno ukazuju na poznat benigni uzrok anemije. Simptomi od strane gastrointestinalnog trakta mogu pomo}i u racionalnom usmeravanju ispitivanja u pravcu ezofagogastroduodenoskopije odnosno kolonoskopije 8,24 .…”

Section: Klini~ki Zna~ajunclassified

“…Mogu}a obja{njenja za anemiju su: negastrointestinalni gubitak krvi (posebno orofaringealni), pogre{na dijagnoza tipa anemije, nutricioni deficit, lezije koje nisu identifikovane (posebno vaskularne malformacije). Ioannou et al 24 su, nakon prospektivne evaluacije, ponudili klini~ki vodi~ za dijagnostikovanje i dalje tretiranje sideropenijske anemije. Anemija je definisana, prema kriterijumima Svetske Zdravstvene Organizacije, kao vrednost Hgb<130g/l za mu{karce i <120g/L za 'ene.…”

Section: Klini~ki Zna~ajunclassified

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Iron deficiency anemia and its importance in gastroenterology clinical practice

et al. 2007

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Iron deficiency anemia (IDA) is a universal problem involving individuals of all ages and both sexes and is a common cause of referral to medical departments. This anemia is one of the most common types of anemia. IDA impairs growth and intellectual development in children and adolescent. In women IDA is most common in reproductive period because of menstrual and pregnancy iron losses. IDA affects roughly 10-30% of all pregnancies and, among others morbidities, may contribute of developing postpartum depression. Among other adult patient, chronic occult gastrointestinal bleeding is the leading cause of IDA. Approximately, one third of patients with anemia have iron deficiency and up to two thirds of patients with IDA have serious gastrointestinal lesions detected with esophagogastroduodenoscopy and colonoscopy, including 10-15% with malignancy. However, in practice not all anemic patients undergo appropriate diagnostic tests to detect iron deficiency. Furthermore, a substantial proportion of patients with IDA do not undergo endoscopic evaluation. The approach to its investigation and subsequent therapy depends upon a comprehensive understanding of iron metabolism and heme synthesis. Once diagnosis of iron deficiency or IDA is established, evaluation for the cause of anemia must be appropriate performed and treatment must include corrective replenishment of body stores.

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AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia

Kaunitz

Ganz

2021

Gastroenterology

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This letter is in response to the recently AGA Clinical Practice Guidelines regarding the gastrointestinal evaluation of iron deficiency anemia (IDA). 1 We thank the editors of Gastroenterology for compiling such complete and well researched guidelines regarding the diagnosis, treatment, and testing for IDA. In particular, the recommendations regarding the management of patients with negative bidirectional endoscopy with occult bleeding should decrease the number of unnecessary procedures performed for this indication. We would like to offer comments on two of the proposed guidelines, as follows.

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Prospective evaluation of a clinical guideline for the diagnosis and management of iron deficiency anemia

Cited by 4 publications

References 0 publications

Blood Transfusion Practices in Upper Gastrointestinal Bleeding: Response to a Landmark Study

Blood Transfusion Practices in Upper Gastrointestinal Bleeding: Response to a Landmark Study

Iron deficiency anemia and its importance in gastroenterology clinical practice

AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia

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