IRON-DEFICIENCY ANEMIA IN GENERAL-PRACTICE - PRESENTATIONS AND INVESTIGATIONS

Twenty-six patients over the age of 50 years with proven iron deficien cy anaemia were identified, investigated and followed up in general pr actice over a five-year period. The anaemia was symptomatic in 50% of patients but only 20% had symptoms related to the gut. Faecal occult b lood testing was positive in five patients only and negative tests occ urred in three patients with significant disease, including one caecal carcinoma. All patients agreed to oesophagogastroduodenoscopy (OGD) a nd fibreoptic sigmoidoscopy carried out on the same occasion. In eight patients, significant abnormalities were found on OGD and in two pati ents on sigmoidoscopy. Four patients declined barium enema examination s, two of whom had significant OGD abnormalities. Barium enema examina tion of the other 22 patients showed polyposis of the colon and a caec al carcinoma and initially missed one carcinoma of the caecum which wa s found subsequently. The likelihood of finding significant disease in iron-deficient patients over 50 years of age is high and should be as sumed to be due to blood loss into the gut. Investigation by OGD, sigm oidoscopy and barium enema in the first instance seems warranted and i s a condition that can be safely managed by the GP.