PROSPECTIVE SURVEY OF INVESTIGATIONS IN OUTPATIENTS REFERRED WITH IRON-DEFICIENCY ANEMIA

Recent evidence has suggested that colonic neoplasm may be missed in p atients presenting with iron deficiency anaemia unless colonic investi gations are performed on all patients even when an alternative cause h as been found. This study prospectively surveyed 114 consecutive patie nts referred from family practitioners to an outpatient clinic for the investigation of iron deficiency anaemia to determine the diagnoses c ontributing to the anaemia, the usefulness of certain clinical feature s, and the role of colonic and other investigations in obtaining the d iagnosis. Upper gastrointestinal lesions contributing to anaemia were identified in 45 patients while colonic lesions were found in 18. Twen ty three patients had a non-gastrointestinal cause for anaemia and in 12 patients no cause was found. Only two patients were identified as h aving colonic neoplasia (a small adenomatous polyp in each case) coexi sting with upper gastrointestinal lesions. Symptoms and signs had a se nsitivity and specificity of upper gastrointestinal disease of 50% and 83% respectively, and 44% and 80% for colonic disease. Endoscopy had a high yield (42%) and duodenal biopsy identified coeliac disease in t hree patients (two were aged >70 years) each of whom had normal folate values. Barium enema had a yield of 13%. All colonic carcinomas occur red in patients >65 years. The coexistence of colonic cancer or large polyps with an upper gastrointestinal lesion identified at endoscopy w as rare in outpatients referred from family practitioners. Clinical sy mptoms and signs were poor indicators of the investigations that will detect a cause for the anaemia. Endoscopy (with duodenal biopsy) shoul d be performed on all patients. The yield from barium enema is so low in young patients that if an upper gastrointestinal cause is found and there are no clinical indicators it would seem unnecessary.