Highlights of new guidelines for managing iron deficiency anemia

Clinicians will wish to read the entire guidelines on managing iron deficiency anemia just published GUT (International Journal of Gastroenterology and Hepatology), but a few important points are worth noting here:

• "Any level of anaemia should be investigated in the presence of iron deficiency."
• "Serum ferritin is the most powerful test for iron deficiency."
• "Gastrointestinal (GI) blood loss from colonic cancer or gastric cancer, and malabsorption in coeliac disease are the most important causes that need to be sought."
• "Upper and lower GI investigations should be considered in all postmenopausal female and all male patients where IDA has been confirmed unless there is a history of significant overt non-GI blood loss."
• "All patients should be screened for coeliac disease."
• "Colonoscopy has advantages over CT colography for investigation of the lower GI tract in IDA, but either is acceptable. Either is preferable to barium enema, which is useful if they are not available."
• "In patients with recurrent IDA and normal OGD and colonoscopy results, Helicobacter pylori should be eradicated if present."
• "Faecal occult blood testing is of no benefit in the investigation of IDA."
• "Rectal examination is seldom contributory, and, in the absence of symptoms such as rectal bleeding and tenesmus, may be postponed until colonoscopy."
• "Urine testing for blood is important in the examination of patients with IDA ."

Determining the cause and treating any type of anemia is of the highest importance—with even borderline anemia the ability of every cell in the body to function is impaired due to suboptimal oxygen delivery. There are a number of posts presenting studies on the depredations of mild anemia that can be seen by typing 'anemia' in the search box above.