Iron Deficiency due to GI Pathology

03/05/2013 by admin | Gastroenterology
  1. 2 causes of iron deficiency:

 

  1. 1. Reduced absorption in GI tract: due to mucosal disease (=coeliac disease [coeliac sprue = flattening of villi and chronic inflammation of intestinal mucosa]), duodenal bypass (=polagastrectomy) or dietary deficiency.
  2. 2. Chronic blood loss: due to menstrual bleeding, PU disease, GI neoplasia (colonic adenomatous polyps, caecal/gastric/rectal carcinoma), hookworm (LEDCs), tropical sprue (marker abnormal flattening of villi and inflammation in intestinal mucosa = malabsorption), severe gastritis/oesophagitis, Intestinal angiodysplasia

 

  1. p/c & o/e: koilonychia, angular stomatitis, pale, brittle hair, prothrombotic state [DVT/PE], post-cricoid web (=Plummer-Vinson syndrome), dysphagia, look for angiodysplastic lesion on lips and buccal mucosa.
  2. There is a link between angiodysplasia and aortic stenosis!
  3. Assess Virchow’s node and any other LNs
  4. Do abdo exam and assess iliac fossae
  5. Do a PR and flexi-sigmoidoscopy in all – even in absence of PR bleeding
  6. At risk: women with heavy periods, previous gastric surgery (=predisposed to gastric cancer), vegans!
  1. Ix:
    1. o FBC (=microcytic anaemia, or B12/folate deficiency =macrocytic[raised MCV]), iron/ferritin levels will be low, and total iron binding capacity high.
    2. o Ferritin is an acute phase reactant and is raised in the face of inflammation – even in iron deficient states.
    3. o Faecal occult blood (FOB): chemical test for haem oxygenase (‘haemoccult’), very sensitive. High false negatives (30% of CRC test negative)
    4. o Endoscopy and colonoscopy: if iron deficient require upper and lower Ix. Duodenal biopsy should be taken to rule out coeliac disease! Polyps identified at colonoscopy should be snared and removed.
    5. o Barium enema: alternative way to image colon
    6. o Small bowel imaging: enema, enteroscopy
  2. Mx:
    1. o Tx underlying cause: gastrointestinal angiodysplasia responds well to continuous oral iron supplementation (for gastric and CRC)
    2. o If no source identified: considering giving iron replacement therapy and repeat Ix. 
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