Intended for healthcare professionals

Clinical Review

Lesson of the week: prevalence of concomitant disease in patients with iron deficiency anaemia

BMJ 1997; 314 doi: (Published 18 January 1997) Cite this as: BMJ 1997;314:206
  1. Simon H Till, registrar in general medicine and rheumatologya,
  2. Michael J Grundman, consultant physician and gastroenterologista
  1. a Department of Gastroenterology Chesterfield and North Derbyshire Royal Hospital Chesterfield S44 5BL
  1. Correspondence to: Dr Grundman
  • Accepted 19 September 1996


How to investigate patients presenting with iron deficiency anaemia is a matter of debate. Undoubtedly one of the commonest lethal, but potentially curable, causes is colonic carcinoma, the second most common cancer in both men and women in the West. Despite this, the colon may not be investigated if an acceptable cause for the anaemia has been found on upper gastrointestinal investigations.

Clinically important concomitant disease, such as benign upper gastrointestinal disease associated with colonic cancer, has been reported in up to 7% of anaemic patients,1 2 3 yet combined upper and lower gastrointestinal investigations are carried out in only a minority of cases with iron deficiency anaemia.4

Patients, methods, and results

We examined the records of 89 consecutive patients referred with iron deficiency anaemia and at least two positive faecal occult blood results between 1989 and 1992. Iron deficiency anaemia was defined by a haemoglobin concentration of <110 g/l in association with a mean corpuscular volume of <80 fl and either a serum ferritin concentration of <10 mg/l or an appropriate response to iron supplementation. Patients were either followed up or their case notes were reviewed or their general practitioner was contacted. The case notes of all patients were reviewed in July 1995, a minimum of three years after initial presentation. We identified “acceptable” causes for the anaemia in 67 patients (table 1)). Six patients had concomitant disease; in three potentially curative surgery was delayed because of the gastroscopy findings (box). Cases 1-7-and a more recent case (8)-show the importance of not ascribing the cause of iron deficiency anaemia to a lesion in …

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