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Iron Deficiency Anemia: A Call for Aggressive Diagnostic Evaluation

Patrick G. Brady, MD
Volume: 100 Issue: 10 October, 2007

Abstract:

Iron deficiency is a prevalent cause of anemia in the United States. It is easily diagnosed by readily available laboratory studies. Although most common in toddlers and women of reproductive age, iron deficiency anemia (IDA) is found in 1 to 2% of men and 2% of women over the age of 50 years.1 Iron deficiency may be caused by prolonged intake of diets low in iron, increased iron requirement (pregnancy and lactation), loss of blood, or gastrointestinal malabsorption of iron. In adults over the age of 50 years, gastrointestinal blood loss is an important cause of iron deficiency. James et al found that 11.2% of patients with IDA had gastrointestinal cancer, and that age >50 years was a significant risk factor for malignancy.2 Since chronic gastrointestinal bleeding may be intermittent, patients with unexplained iron deficiency anemia need to be managed like those with positive fecal occult blood tests. Therefore, the standard of care in men and postmenopausal women with IDA is to evaluate the gastrointestinal tract for a source of blood loss regardless of the results of fecal occult blood testing.3

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References:

1. Looker AC, Dallman PR, Carroll MD, et al. Prevalence of iron deficiency anemia in the United States.JAMA 1997;277:973–976.
 
2. James MW, Chen CM, Goddard WP, et al. Risk factors for gastrointestinal malignancy in patients with iron-deficiency anaemia. Eur J Gastroenterol Hepatol 2005;17:1197–1203.
 
3. American Gastroenterological Association medical position statement: evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2000;118:197–201.
 
4. Ioannou GN, Spector J, Rockey DC. Predictors of endoscopic and laboratory evaluation of iron deficiency anemia in hospitalized patients. South Med J 2007;100:978–986.
 
5. Smieja MJ, Cook DJ, Hunt DL, et al. Recognizing and investigating iron-deficiency anemia in hospitalized elderly people. CMAJ 1996;155:691–696.
 
6. Capruso G, Baccini F, Osborn J, et al. Can patient characteristics predict the outcome of endoscopic evaluation of iron deficiency anemia: a multiple logistic regression analysis. Gastrointest Endosc 2004;59:766–771.
 
7. Cappell M. Safety and efficacy of colonoscopy after myocardial infarction: an analysis of 100 study patients and 100 control patients at two tertiary cardiac referral hospitals. Gastrointest Endosc 2004; 60:901–909.

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