Survey of patients with iron deficiency anemia in haematology outpatient clinic
DOI:
https://doi.org/10.6016/ZdravVestn.2523Keywords:
iron deficiency anaemia, microcytic anaemia, anaemia of chronic disease, hepcidin, iron supplementsAbstract
Background: Iron deficiency anaemia (IDA) is the most prevalent type of anaemia and a common cause for patient referrals to the haematology outpatient clinic. The aim of this study was to determine the number of patients with IDA treated at the Haematology Outpatient Clinic of the UMC Ljubljana in the period of two years, as well as to inquire into the causes for their referrals to the clinic, patient characteristics, their complete blood count results at initial examination, the prescribed therapy, the number and the causes of their follow-up visits. We draw special attention to the IDA onset mechanism, the microcytic anaemia therapy principles and the indications prompting a referral of an IDA patient to the haematology specialist.
Methods: We undertook a retrospective analysis of the medical records of patients who were referred to the Haematology outpatient clinic of the UMC Ljubljana for examination in the two-year period between 1 January 2014 and 31 December 2015 and had been diagnosed with IDA on the basis of their clinical picture and their CBC values. Data were collected with the Hipokrat IT system and statistically evaluated with Microsoft Excel.
Results: In the period relevant for our research, 277 patients of those who were referred to the Haematology outpatient clinic for medical examination were diagnosed with IDA. 11.6 % of these patients were male and 88.4 % female; 62.1 % of the female patients were of childbearing age. IDA was specified as the referral diagnosis in the cases of no more than 39 % of the patients referred to the specialist outpatient clinic, whilst the medical condition of the remaining percentage of patients was not identified by the referring doctor. Comorbidities were observed in 50.2 % of the patients, and for 62.5 % of the patients a follow-up appointment was scheduled by the treating haematologist. Of all patients, 63.5 % were treated with an intravenous iron preparation during their first examination at the outpatient clinic and a transfusion of erythrocytes was administered during such an examination to 4.3 % of the patients.
Conclusion: Patients with IDA were often treated at our Haematology Outpatient Clinic in the relevant two-year period. The data indicates a poor recognition rate of this prevalent type of anaemia. IDA is not a blood disorder and the referral of IDA patients to the Haematology Outpatient Clinic is justified in the case of severe microcytic anaemia, when the patient does not respond to the oral or intravenous iron replacement therapy or if a concomitant change in the CBC persists despite the effective treatment with iron preparations.
Downloads
References
Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-43. https://doi.org/10.1056/NEJMra1401038 https://pubmed.ncbi.nlm.nih.gov/25946282
Short MW, Domagalski JE. Iron deficiency anemia: evaluation and management. Am Fam Physician. 2013;87(2):98-104. https://pubmed.ncbi.nlm.nih.gov/23317073
Nishimura S, Matsuzaki H, Fujimoto K, Kawakita M, Takatsuki K. Münchhausen syndrome with severe iron deficiency anemia. Rinsho Ketsueki. 1992;33(4):478-82. https://pubmed.ncbi.nlm.nih.gov/1602612
Khadem G, Scott IA, Klein K. Evaluation of iron deficiency anaemia in tertiary hospital settings: room for improvement? Intern Med J. 2012;42(6):658-64. https://doi.org/10.1111/j.1445-5994.2012.02724.x https://pubmed.ncbi.nlm.nih.gov/22288902
World Health Organ. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: WHO; 2011[cited 2017 Jan 10]. Available from: http://www.who.int/vmnis/indicators/haemoglobin.pdf
. Laboratorijski vodnik UKC Ljubljana, INTKOHem- Interna klinika - KO za hematologijo-Specializirani hematološki laboratorij. [cited 2017 Jan 10]. Available from: http://lab.biarti.si/
. Laboratorijski vodnik UKC Ljubljana, KIKKB Klinični inštitut za klinično kemijo in biokemijo. [cited 2017 Jan 10].
Alleyne M, Horne MK, Miller JL. Individualized treatment for iron-deficiency anemia in adults. Am J Med. 2008;121(11):943-8. https://doi.org/10.1016/j.amjmed.2008.07.012 https://pubmed.ncbi.nlm.nih.gov/18954837
Mills HL, Abdel-Baki MS, Teruya J, Dietrich JE, Shah MD, Mahoney D, et al. Platelet function defects in adolescents with heavy menstrual bleeding. Haemophilia. 2014;20(2):249-54. https://doi.org/10.1111/hae.12293 https://pubmed.ncbi.nlm.nih.gov/24251971
Dilley A, Drews C, Miller C, Lally C, Austin H, Ramaswamy D, et al. von Willebrand disease and other inherited bleeding disorders in women with diagnosed menorrhagia. Obstet Gynecol. 2001;97(4):630-6. https://pubmed.ncbi.nlm.nih.gov/11275041
DeLoughery TG. Microcytic anemia. N Engl J Med. 2014;371(14):1324-31. https://doi.org/10.1056/NEJMra1215361 https://pubmed.ncbi.nlm.nih.gov/25271605
Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Therap Adv Gastroenterol. 2011;4(3):177-84. https://doi.org/10.1177/1756283X11398736 https://pubmed.ncbi.nlm.nih.gov/21694802
Bermejo F, García-López S. A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. World J Gastroenterol. 2009;15(37):4638-43. https://doi.org/10.3748/wjg.15.4638 https://pubmed.ncbi.nlm.nih.gov/19787826
Todorova B. Talasemije v Sloveniji. 2014[cited 2017 Jan 10]. Available from: http://www.hematologija.org/admin/files/news/pics/file/Todorova%20B%20p2014.pdf
Nuchprayoon I, Sukthawee B, Nuchprayoon T. Red cell indices and therapeutic trial of iron in diagnostic work-up for anemic Thai females. J Med Assoc Thai. 2003;86:S160-9. https://pubmed.ncbi.nlm.nih.gov/12929984
Körber C, Wölfler A, Neubauer M, Robier C. Short Communication Red blood cell morphology in patients with β-thalassemia minor. J Lab Med. 2016;41(1):49-52. https://doi.org/10.1515/labmed-2016-0052
Ganz T. Hepcidin and iron regulation, 10 years later. Blood. 2011;117(17):4425-33. https://doi.org/10.1182/blood-2011-01-258467 https://pubmed.ncbi.nlm.nih.gov/21346250
Locatelli F, Aljama P, Bárány P, Canaud B, Carrera F, Eckardt KU, et al.; European Best Practice Guidelines Working Group. Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant. 2004;19:ii1-47. https://pubmed.ncbi.nlm.nih.gov/15206425
Thomas DW, Hinchliffe RF, Briggs C, Macdougall IC, Littlewood T, Cavill I; British Committee for Standards in Haematology. Guideline for the laboratory diagnosis of functional iron deficiency. Br J Haematol. 2013;161(5):639-48. https://doi.org/10.1111/bjh.12311 https://pubmed.ncbi.nlm.nih.gov/23573815
Hershko C, Camaschella C. How I treat unexplained refractory iron deficiency anemia. Blood. 2014;123(3):326-33. https://doi.org/10.1182/blood-2013-10-512624 https://pubmed.ncbi.nlm.nih.gov/24215034
Sinniah R, Doggart JR, Neill DW. Diurnal variations of the serum iron in normal subjects and in patients with haemochromatosis. Br J Haematol. 1969;17(4):351-8. https://doi.org/10.1111/j.1365-2141.1969.tb01381.x https://pubmed.ncbi.nlm.nih.gov/5346408
Skopec B, Zver S. Reaktivne spremembe krvne slike in osnove zdravljenja anemije zaradi pomanjkanja železa. Zdrav Vestn. 2008;77(1):161-5.
Akan H, Güven N, Aydogdu I, Arat M, Beksaç M, Dalva K. Thrombopoietic cytokines in patients with iron deficiency anemia with or without thrombocytosis. Acta Haematol. 2000;103(3):152-6. https://doi.org/10.1159/000041038 https://pubmed.ncbi.nlm.nih.gov/10940653
Bleeker JS, Hogan WJ. Thrombocytosis: diagnostic evaluation, thrombotic risk stratification, and risk-based management strategies. Thrombosis. 2011;2011:536062. https://doi.org/10.1155/2011/536062 https://pubmed.ncbi.nlm.nih.gov/22084665
Lim Y, Lee EY, Choi IS, Kim TY, Yoon SS, Kim KH. Leukopenia in patients with iron deficiency anemia. Blood. 2011;118(21):5279.
Lima CS, Paula EV, Takahashi T, Saad ST, Lorand-Metze I, Costa FF. Causes of incidental neutropenia in adulthood. Ann Hematol. 2006;85(10):705-9. https://doi.org/10.1007/s00277-006-0150-0 https://pubmed.ncbi.nlm.nih.gov/16807747
Lopas H, Rabiner SF. Thrombocytopenia associated with iron deficiency anemia. A report of five cases. Clin Pediatr (Phila). 1966;5(10):609-16. https://doi.org/10.1177/000992286600501008 https://pubmed.ncbi.nlm.nih.gov/5926915
Morris VK, Spraker HL, Howard SC, Ware RE, Reiss UM. Severe thrombocytopenia with iron deficiency anemia. Pediatr Hematol Oncol. 2010;27(5):413-9. https://doi.org/10.3109/08880011003739455 https://pubmed.ncbi.nlm.nih.gov/20670168
Ganti AK, Shonka NA, Haire WD. Pancytopenia due to iron deficiency worsened by iron infusion: a case report. J Med Case Reports. 2007;1(1):175. https://doi.org/10.1186/1752-1947-1-175 https://pubmed.ncbi.nlm.nih.gov/18067664
Das Makheja K, Kumar Maheshwari B, Arain S, Kumar S, Kumari S, Vikash . The common causes leading to pancytopenia in patients presenting to tertiary care hospital. Pak J Med Sci. 2013;29(5):1108-11. https://pubmed.ncbi.nlm.nih.gov/24353701
Andrews NC. Iron metabolism: iron deficiency and iron overload. Annu Rev Genomics Hum Genet. 2000;1(1):75-98. https://doi.org/10.1146/annurev.genom.1.1.75 https://pubmed.ncbi.nlm.nih.gov/11701625
Andoljšek D. Bolezni krvi in krvotvornih organov. In: Kocijančič A, Mrelje V, Štajer D, černelč P, eds. Interna medicina. 3rd ed. Ljubljana: Littera picta; 2011. pp. 1243-393.
Zijp IM, Korver O, Tijburg LB. Effect of tea and other dietary factors on iron absorption. Crit Rev Food Sci Nutr. 2000;40(5):371-98. https://doi.org/10.1080/10408690091189194 https://pubmed.ncbi.nlm.nih.gov/11029010
Marignani M, Angeletti S, Bordi C, Malagnino F, Mancino C, Delle Fave G, et al. Reversal of long-standing iron deficiency anaemia after eradication of Helicobacter pylori infection. Scand J Gastroenterol. 1997;32(6):617-22. https://doi.org/10.3109/00365529709025109 https://pubmed.ncbi.nlm.nih.gov/9200297
Nairz M, Schroll A, Sonnweber T, Weiss G. The struggle for iron - a metal at the host-pathogen interface. Cell Microbiol. 2010;12(12):1691-702. https://doi.org/10.1111/j.1462-5822.2010.01529.x https://pubmed.ncbi.nlm.nih.gov/20964797
Zager RA, Johnson AC, Hanson SY. Parenteral iron therapy exacerbates experimental sepsis. Kidney Int. 2004;65(6):2108-12. https://doi.org/10.1111/j.1523-1755.2004.00742.x https://pubmed.ncbi.nlm.nih.gov/15149323
Moretti D, Goede JS, Zeder C, Jiskra M, Chatzinakou V, Tjalsma H, et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood. 2015;126(17):1981-9. https://doi.org/10.1182/blood-2015-05-642223 https://pubmed.ncbi.nlm.nih.gov/26289639
Schrier SL. So you know how to treat iron deficiency anemia. Blood. 2015;126(17):1971. https://doi.org/10.1182/blood-2015-09-666511 https://pubmed.ncbi.nlm.nih.gov/26494915
Bircher AJ, Auerbach M. Hypersensitivity from intravenous iron products. Immunol Allergy Clin North Am. 2014;34(3):707-23. https://doi.org/10.1016/j.iac.2014.04.013 https://pubmed.ncbi.nlm.nih.gov/25017687
Rampton D, Folkersen J, Fishbane S, Hedenus M, Howaldt S, Locatelli F, et al. Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management. Haematologica. 2014;99(11):1671-6. https://doi.org/10.3324/haematol.2014.111492 https://pubmed.ncbi.nlm.nih.gov/25420283
Carson JL, Strair R. Transfusion strategies in hematologic and nonhematologic disease. Hematology (Am Soc Hematol Educ Program). 2014;2014(1):548-52. https://doi.org/10.1182/asheducation-2014.1.548 https://pubmed.ncbi.nlm.nih.gov/25696909
Goddard AF, James MW, McIntyre AS, Scott BB; British Society of Gastroenterology. Guidelines for the management of iron deficiency anaemia. Gut. 2011;60(10):1309-16. https://doi.org/10.1136/gut.2010.228874 https://pubmed.ncbi.nlm.nih.gov/21561874
Centralna baza zdravil 2. [cited 2017 Jan 11]. Available from: http://www.cbz.si/cbz/bazazdr2.nsf/Search?SearchView&Query=(%5BSEZNAMUCINKNAZIV%5D=_%C5%BEelezo*)&SearchOrder=4&SearchMax=301
Published
Issue
Section
License
The Author transfers to the Publisher (Slovenian Medical Association) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Slovenian Medical Association) has the right to transfer the rights of acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
