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      Evaluation and Treatment of Iron Deficiency Anemia: A Gastroenterological Perspective

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          Abstract

          A substantial volume of the consultations requested of gastroenterologists are directed towards the evaluation of anemia. Since iron deficiency anemia often arises from bleeding gastrointestinal lesions, many of which are malignant, establishment of a firm diagnosis usually obligates an endoscopic evaluation. Although the laboratory tests used to make the diagnosis have not changed in many decades, their interpretation has, and this is possibly due to the availability of extensive testing in key populations. We provide data supporting the use of the serum ferritin as the sole useful measure of iron stores, setting the lower limit at 100 μg/l for some populations in order to increase the sensitivity of the test. Trends of the commonly obtained red cell indices, mean corpuscular volume, and the red cell distribution width can provide valuable diagnostic information. Once the diagnosis is established, upper and lower gastrointestinal endoscopy is usually indicated. Nevertheless, in many cases a gastrointestinal source is not found after routine evaluation. Additional studies, including repeat upper and lower endoscopy and often investigation of the small intestine may thus be required. Although oral iron is inexpensive and usually effective, there are many gastrointestinal conditions that warrant treatment of iron deficiency with intravenous iron.

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          Most cited references81

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          Assessing iron status: beyond serum ferritin and transferrin saturation.

          The increasing prevalence of multiple comorbidities among anemic patients with chronic kidney disease has made the use of serum ferritin and transferrin saturation more challenging in diagnosing iron deficiency. Because serum ferritin is an acute-phase reactant and because the inflammatory state may inhibit the mobilization of iron from reticuloendothelial stores, the scenario of patients with serum ferritin >800 ng/ml, suggesting iron overload, and transferrin saturation <20%, suggesting iron deficiency, has become more common. This article revisits the basis for the Kidney Disease Outcomes Quality Initiative recommendations regarding the use of serum ferritin and transferrin saturation in guiding iron therapy, then explores some of the newer alternative markers for iron status that may be useful when serum ferritin and transferrin saturation are insufficient. These newer tests include reticulocyte hemoglobin content, percentage of hypochromic red cells, and soluble transferrin receptor, all of which have shown some promise in limited studies. Finally, the role of hepcidin, a hepatic polypeptide, in the pathophysiology of iron mobilization is reviewed briefly.
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            Iron, anaemia, and inflammatory bowel diseases.

            Iron deficiency anaemia is one of the most common disorders in the world. Also, one third of inflammatory bowel disease (IBD) patients suffer from recurrent anaemia. Anaemia has significant impact on the quality of life of affected patients. Chronic fatigue, a frequent IBD symptom itself, is commonly caused by anaemia and may debilitate patients as much as abdominal pain or diarrhoea. Common therapeutic targets are the mechanisms behind anaemia of chronic disease and iron deficiency. It is our experience that virtually all patients with IBD associated anaemia can be successfully treated with a combination of iron sucrose and erythropoietin, which then may positively affect the misled immune response in IBD.
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              Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases.

              Anemia is a common complication of inflammatory bowel diseases. An international working party has formed and developed guidelines for evaluation and treatment of anemia and iron deficiency that should serve practicing gastroenterologists. Within a total of 16 statements, recommendations are made regarding diagnostic measures to screen for iron- and other anemia-related deficiencies regarding the triggers for medical intervention, treatment goals, and appropriate therapies. Anemia is a common cause of hospitalization, prevents physicians from discharging hospitalized patients, and is one of the most frequent comorbid conditions in patients with inflammatory bowel disease. It therefore needs appropriate attention and specific care.
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                Author and article information

                Contributors
                +1-310-2683879 , +1-310-2684811 , jake@ucla.edu
                Journal
                Dig Dis Sci
                Digestive Diseases and Sciences
                Springer US (Boston )
                0163-2116
                1573-2568
                27 January 2010
                27 January 2010
                March 2010
                : 55
                : 3
                : 548-559
                Affiliations
                [1 ]Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA USA
                [2 ]Cedars-Sinai—VA Residency Program, Los Angeles, CA USA
                [3 ]Department of Medicine, School of Medicine, University of California Los Angeles, Los Angeles, CA USA
                [4 ]Brentwood Biomedical Research Institute, Los Angeles, CA 90073 USA
                [5 ]West Los Angeles VA Medical Center, Bldg. 114, Suite 217, 11301 Wilshire Blvd., Los Angeles, CA 90073 USA
                Article
                1108
                10.1007/s10620-009-1108-6
                2822907
                20108038
                8adcd88e-5c46-42ad-a61e-88518db81e53
                © The Author(s) 2010
                History
                : 10 September 2009
                : 15 December 2009
                Categories
                Review
                Custom metadata
                © Springer Science+Business Media, LLC 2010

                Gastroenterology & Hepatology
                micronutrient deficiencies,ferritin,red cell indices,clinical diagnosis

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