Family Practice Advance Access originally published online on January 11, 2005
Family Practice 2005 22(1):58-61; doi:10.1093/fampra/cmh705
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Iron deficiency anemia in patients without gastrointestinal symptomsa prospective study
Departments of a Medicine, b Diagnostic Imaging and c Gastroenterology, Sapir Medical Center, Kfar-Saba and d Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Correspondence to Professor M.Lishner, Department of Medicine, Meir Hospital, Sapir Medical Center, Kfar-Saba, Israel; Email: niv_em{at}netvision.net.il
Background and objectives. Chronic gastrointestinal (GI) bleeding is the leading cause of iron deficiency anaemia (IDA) in men older than 50 years and post-menopausal women. There is a scarcity of data regarding IDA patients without GI symptoms or signs. We conducted a prospective study to determine the prevalence and the locations of the GI tract lesions in patients with asymptomatic IDA.
Methods. Forty-eight patients with asymptomatic IDA (25 men older than 50 years and 23 post-menopausal women) underwent colonoscopy, gastroscopy and abdominal computed tomography (CT) with contrast agent.
Results. An anaemia-causing lesion was found in 14 (29%) and 16 (33%) patients in the upper and the lower GI tract, respectively. The prevalence of dual lesions (in both the upper and lower GI tract) was low (6%). In 14 (29%) patients, a malignancy, predominantly right-sided colon carcinoma, was responsible for the IDA. Only one patient had a lesion in the small bowel. In 14 (29%) patients, the work-up was negative.
Conclusion. Our prospective study demonstrates a high rate of malignancy, predominantly right-sided colon carcinoma, in men older than 50 years and post-menopausal women with asymptomatic IDA. This finding obligates a complete and rigorous GI tract examination in this group of patients, especially of the right colon.
Keywords. Asymptomatic, iron deficiency anaemia.