Investigating IDA (BSG Guideline)

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• Investigating IDA (BSG Guideline)
• And
• An overview of Obscure GI Bleed
• Dr.D.Ghosh
• Gastroenterology Registrar

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• Anaemia lt10-11.5g/dl for women
• lt12.5-13.8g/dl for men
• Not known at what level of Hb Ix should be
  initiated. No reason why mild anaemia should be
  less indicative of important disease than severe
  anaemia
• Iron deficiency serum ferritinlt12
• MCVlt 76
• Transferrin satlt30
• Bone marrow aspiration
• Therapeutic response
• Sr.transferrin receptor/ferritin ratio

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Investigation

• History - dietary,drugs and family hx
• Examination-abd mass/cutaneous
• GI evaluationall with confirmed IDA unless non
  GI blood loss
• Order of Ix in absence of symptoms-local
  availability
• OGD with small bowel bx yield 30-50
• Barium meal with coeliac serology if unable
• Colonoscopyunless OGD positive for Ca or coeliac
  ALL pts should have lower GI ix
• Ba enema is a sufficent alternative with/without
  sigmoidoscopy (can omit in absence of lower GI
  symptoms and a normal PR Exam)
• FOB is of no benefit in the investigation of IDA
  insensitive and nonspecific
• The management of IDA is often suboptimal with
  most patients being incompletely investigated if
  at all

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Iron treatment

• Different formulations
• Vit c
• Parental iron
• Target increase by 2 every 3wks
• Replenish stores3 more months
• Monitor3 monthly for a yr then after one yr
• Reassuring to know that IDA does not return in
  most pts in whom no cause is found after ix

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• Co-morbidity appropriateness should be carefully
  considered and discussed with pts and carers.
• Pre-menopausal women
• 5-10 incidence in that group
• Hx unreliable to quantify
• Ix only ifgt45yrs
• Ogd SI bx if upper GI symptoms
• But coeliac serology in all
• Lower GI ix only if symptoms,family hx,refractory
  after correction of potential cause
• Post-gastrectomyif refractory or occuring long
  after

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Etiology of small-bowel bleeding
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Classification of vascular malformations that
cause gastrointestinal hemorrhage
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Arteriovenous malformations in the
gastrointestinal tract
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Endoscopic views of small-bowel arteriovenous
malformations
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Endoscopic views of small-bowel arteriovenous
malformations
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Small-bowel arteriovenous malformations as the
cause of gastrointestinal hemorrhage
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Small-bowel tumors as the cause of
gastrointestinal hemorrhage
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Gastrointestinal hemorrhage of obscure origin
arising from small-bowel tumors
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Barium studies in the evaluation of small-bowel
bleeding
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Types of nuclear medicine studies for the
evaluation of small-bowel bleeding
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Diagnostic yield of nuclear medicine studies for
small-bowel bleeding
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Diagnostic value of Meckel's scan in the adult
population
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Arteriography in the diagnosis of small-bowel
bleeding
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Arteriography in gastrointestinal bleeding
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Enteroscopy in the diagnosis and management of
small-bowel hemorrhage
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Yield of jejunoscopy for small-bowel bleeding
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Treatment options for small-bowel bleeding
lesions
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Evaluation and management of acute hemorrhage
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Evaluation and management of chronic
gastrointestinal bleeding of obscure origin
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• Thank you