Investigating IDA BSG Guideline And An overview of

Investigating IDA (BSG Guideline) And An overview of Obscure GI Bleed Dr. D. Ghosh Gastroenterology Registrar

Anaemia: <10 -11. 5 g/dl for women <12. 5 -13. 8 g/dl for men Not known at what level of Hb Ix should be initiated. No reason why mild anaemia should be less indicative of important disease than severe anaemia Iron deficiency: serum ferritin<12 MCV< 76 Transferrin sat<30% Bone marrow aspiration Therapeutic response Sr. transferrin receptor/ferritin ratio

Investigation History - dietary, drugs and family hx Examination-abd mass/cutaneous GI evaluation: all with confirmed IDA unless non GI blood loss Order of Ix in absence of symptoms-local availability OGD with small bowel bx : yield 30 -50% Barium meal with coeliac serology if unable Colonoscopy: unless OGD positive for Ca or coeliac ALL pts should have lower GI ix Ba enema is a sufficent alternative with/without sigmoidoscopy (can omit in absence of lower GI symptoms and a normal PR Exam) FOB is of no benefit in the investigation of IDA –insensitive and nonspecific “The management of IDA is often suboptimal with most patients being incompletely investigated if at all”

Iron treatment • • Different formulations Vit c Parental iron Target: increase by 2 every 3 wks Replenish stores: 3 more months Monitor: 3 monthly for a yr & then after one yr Reassuring to know that IDA does not return in most pts in whom no cause is found after ix

• Co-morbidity: appropriateness should be carefully considered and discussed with pts and carers. • Pre-menopausal women: – – – 5 -10% incidence in that group Hx unreliable to quantify Ix only if>45 yrs Ogd & SI bx if upper GI symptoms But coeliac serology in all Lower GI ix only if symptoms, family hx, refractory after correction of potential cause • Post-gastrectomy: if refractory or occuring long after