Anaemia as indication for colonoscopy in single endoscopy unit
Ammar Shahin, Hassan Zaid
Gastroenterology, St. James's Hospital
iron-deficiency anaemia (IDA) has a prevalence of 2–5% amongst adult men and post-menopausal women, the commonest cause being bleeding from the gastrointestinal tract. Other types of anaemia caused by other etiologies and GI investigations are not indicated. For IDA the BSG guidelines recommend that all men and all post-menopausal women undergo gastrointestinal investigations with OGD, colonoscopy, and coeliac serology. Pre-menopausal women under 50 years of age should have coeliac serology only checked; in this group, colonoscopy and/or OGD is reserved for symptomatic patients or those with a strong family history. Hypoferritinaemia (low ferritin without anaemia) is more common than IDA, but opinion is divided on the need for investigations;
Anaemia is a frequent referral for endoscopic investigation, not infrequently colonoscopies are performed. Our aim to review the appropriateness of colonoscopy referrals with the BSG guidelines.
The data of the patients who had colonoscopies performed in 3 months were reviewed, this includes FBC, ferritin and endoscopy results.
136 patients had colonoscopies done in our endoscopy unit in 3 months to investigate anaemia. The patients age range from 35- 91 years of age, Haemoglobin ranges from 6.3-14.9. 47 patients had low MCV, (26 males and 21 females of whom 12 were premenopausal), 36 patients had low ferritin, 27 patients had both low MCV and low ferritin (15 males and 12 females of whom 5 were premenopausal). 2 patients were found to have colorectal cancer both had microcytic anaemia, 1 patient had newly diagnosed colitis, one patient diagnosed with gastric cancer on OGD and the procedure was incomplete in 4 patients in whom CT colonography was unremarkable.
Frequently endoscopic referrals to investigate of anaemia do not suggest iron deficiency anaemia. Patients may have gone through invasive investigations unnecessarily. The 2 patients who had colorectal cancer, had microcytic anaemia. This may subsequently lead to delay in diagnosis of other causes of anaemia like serious haematological conditions. We are changing our endoscopy referral template to include red blood cells indices, and inform GPs and staff of the result of this audit.