The dedicated iron deficiency anaemia clinic – a fifteen-year experience

Objective : To report our cumulative experience from a dedicated IDA clinic over the last 15 years – with particular emphasis on referral rate, uptake of investigation, impact on endoscopy services, diagnostic yield of GI investigation, and the issue of recurrent IDA. Method : A series of analyses of a register of 2808 referrals to the Poole IDA clinic between 2004 and 2018. Results : The study population of 2808 had a sex ratio of 1.9 (F/M) and a median age of 72 years (IQR : 60 - 79). A rising referral rate over the study period appears to be plateauing at around 2 cases per 1000 population per annum. On the basis of a snapshot audit, investigation of IDA may now account for over 20% of all diagnostic endoscopies. Overall, 86% of cases underwent examination of the upper and lower GI tract. Significant GI pathology was identified in 27% of the investigated cohort. Adenocarcinoma of the upper or lower GI tract was found in 8.3%, the majority in the right colon. The prevalence of recurrent IDA was estimated at 12.4%, and the results of investigation of this sub-group are reported. Conclusion : Unexplained IDA is common, particularly in those over 60 years, and may be the first indication of underlying GI malignancy in over 8% of cases. Unresolved challenges include accommodating the resulting endoscopy workload, establishing a risk / benefit ratio for investigating those with major co-morbidities, and the management of recurrent IDA.