How would you investigate a patient with Iron deficiency anaemia?
I would investigate him in accordance with the guidelines set by the British Society Of gastroenterology
History
- Diet
- NSAID
- Familial – Malabsorbtion, Thalasaemia, bleeding diathesis, Telangiectasia
- Blood donation
Examination
- Peutz-Jeghers
- PR exam
- Urine – 1% Iron deficiency anaemia have a Renal tract malignancy
Investigation
- Take inot context other co morbidities
- Upper + lower GI investigations
- I would do a Barium enema as it carries a risk or perforation of 1:10,0000. It has a mortality of 1:60,000.
- A colonoscopy carries a risk of perforation 1:700 and a mortality of 10% if this happens i.e 1:7000. A flexi will not visualise the caecum so is not useful to investigate the colon for anaemia.
- tTG – tissue transglutaminase
- Serology for anti-tTG antibodies has superseded older serological tests (anti-endomysium, anti-gliadin and anti-reticulin) and has a strong sensitivity (99%) and specificity (>90%) for identifying coeliac disease. Modern anti-tTG assays rely on a human recombinant protein as an antigen
- If TTG is negative – D2 biopies must be done
- IF Iron deficiency is transfusion dependent – then do small bowel studies e.g enteroscopy looking for telangiectasia. Barium follow through if Crohns is suspected
- H Pylori can impair iron uptake
