Published online Feb 6, 2016. doi: 10.4292/wjgpt.v7.i1.139
Peer-review started: July 15, 2015
First decision: November 11, 2015
Revised: November 27, 2015
Accepted: December 29, 2015
Article in press: January 4, 2016
Published online: February 6, 2016
AIM: To determine whether patients hospitalized with gastrointestinal (GI) blood loss anemia are being checked and treated for iron deficiency.
METHODS: Retrospective chart review was conducted for all patients admitted to a single tertiary care hospital between 11/1/2011 and 1/31/2012 for any type of GI bleeding. The primary endpoint was the percentage of patients who had their iron studies checked during a hospitalization for GI blood loss anemia. Secondary outcomes included percentage of anemic GI bleeders who had adequate documentation of anemia and iron deficiency, and those who were treated for their iron deficiency. Then we tried to identify possible predictors of checking iron studies in an attempt to understand the thought process that physicians go through when managing these patients. Iron deficiency was defined as Iron saturation less than 15% or ferritin level less than 45 μg/L. Anemia was defined as hemoglobin level less than 13 g/dL for males and 12 g/dL for females.
RESULTS: Three hundred and seven GI bleeders were hospitalized during the study period, and 282 of those (91.9%) had anemia during their hospital stay. Ninety-five patients (30.9%) had iron studies performed during hospitalization, and 45 of those (47.4%) were actually found to be iron deficient. Only 29 of those 45 iron deficient patients were discharged home on iron supplements. Of the 282 patients that had anemia during hospitalization, 50 (17.7%) had no documentation of the anemia in their hospital chart. Of the 45 patients that had lab proven iron deficiency anemia (IDA), only 22 (48.5%) had documentation of IDA in at least one note in their chart. Predictors of checking iron studies in anemic GI bleeders were lower mean corpuscular volume, documentation of anemia, having fecal occult blood testing, not having hematemesis or past history of GI bleeding. There were no significant differences between the teaching and non-teaching services in any patient characteristics or outcomes.
CONCLUSION: Iron deficiency is under-diagnosed, under-recognized even when iron studies were checked, and under-treated in hospitalized patients with GI bleeding.
Core tip: Iron deficiency anemia (IDA) is under-diagnosed and under treated in hospitalized gastrointestinal (GI) bleeders. Less than a third of our patients had evaluation of their anemia to detect IDA. Around half of these investigated patients had lab proven IDA. Less than two thirds of those patients with proven IDA received iron supplementation, which means that IDA was either under-recognized or disregarded on purpose. In an attempt to understand the reasoning of physicians leading to this discrepancy, we analyzed predictors of checking iron studies on these hospitalized GI bleeders and the main predictors were lower mean corpuscular volume and early documentation of anemia in the chart.