Introduction

Iron deficiency anaemia (IDA) is a frequent reason for consultation with a high consumption of health resources both for its diagnosis and for its treatment.

Aims & Methods

To evaluate the characteristics of patients referred to a specialized gastrointestinal (GI) consultation for IDA without macroscopic haemorrhage and the impact of this specialized evaluation on the consumption of health resources. We performed a retrospective observational study of patients evaluated in a specialized gastrointestinal hospital consultation for IDA from January 2021 to October 2023.

Results

We evaluated 218 patients where 134 were excluded due to macroscopic haemorrhage. Finally, 84 patients were analysed, 63% were men with a median age of 73 years (range 39-93) and a median Charlson index of 6 (range 0-15). The median time from the diagnosis of IDA to the first gastrointestinal visit was 46 months (range 1-161). 74% of the patients had been evaluated by another specialty previously. 43% were on antiplatelet treatment and 31% on anticoagulant treatment. The aetiology of anaemia was multifactorial in 24% (n=20) and in those with iron deficiency the most frequent cause was angiodysplasias (42%) but in up to 19% of cases the aetiology was not found despite a complete evaluation.
During follow-up, 58% required an anticoagulation switch, requiring definitive withdrawal of anticoagulation in 8% of patients. Prior to the GI consultation, only one patient was under somatostatin analogues treatment, which was subsequently started in 17 new patients. During follow-up, 12% (n=10) were included in a special management group with parallel blood test monitoring by the primary care physician for a more thoroughly monitorisation of the haemoglobin levels.
When comparing the consumption of health resources in the year before and after the GI assessment, a non-significant trend was observed towards a lower need for gastroscopies [0.87 vs. 0.65, p=0.07], but we found an statistically significant reduction in the number of colonoscopies [0.88 vs. 0.40, p<0.001]. We also observed a significant increase in the mean haemoglobin [10.6 g/dL vs. 12.1 g/dL, p<0.001] without statistically significant differences in the number of blood transfusion [2.82 units vs. 2.30 units, p=0.21] or intravenous iron therapy [1.44 g vs. 1.50 g, p=0.74] before and after the GI assessment respectively. A significant reduction in emergency department visits was also observed [0.79 vs. 0.43, p=0.002] as in hospital admissions [0.46 vs. 0.23, p=0.004] related to anaemia or its complications.
During follow-up, 12 patients died (none due to haemorrhage or anaemia), resulting in a cumulative mortality incidence of 6.7 deaths per 100 patients/year.

Conclusion

Multimorbid patients with iron deficiency anaemia benefit from the care of a specialized digestive consultation which is associated with a decrease in the use of health resources.