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      Reporting new cases of anaemia in primary care settings in Crete, Greece: a rural practice study

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          Abstract

          Background

          Early diagnosis of anaemia represents an important task within primary care settings. This study reports on the frequency of new cases of anaemia among patients attending rural primary care settings in Crete (Greece) and to offer an estimate of iron deficiency anaemia (IDA) frequency in this study group.

          Methods

          All patients attending the rural primary health care units of twelve general practitioners (GPs) on the island of Crete for ten consecutive working days were eligible to participate in this study. Hemoglobin (Hb) levels were measured by portable analyzers. Laboratory tests to confirm new cases of anaemia were performed at the University General Hospital of Heraklion.

          Results

          One hundred and thirteen out of 541 recruited patients had a low value of Hb according to the initial measurement obtained by the use of the portable analyzer. Forty five (45.5%) of the 99 subjects who underwent laboratory testing had confirmed anaemia. The mean value of the Hb levels in the group with confirmed anaemia, as detected by the portable analyzer was 11.1 g/dl (95% Confidence Interval (CI) from 10.9 to 11.4) and the respective mean value of the Hb levels obtained from the full blood count was 11.4 g/dl (95% CI from 11.2 to 11.7) ( P = 0.01). Sixteen out of those 45 patients with anaemia (35.6%) had IDA, with ferritin levels lower than 30 ng/ml.

          Conclusion

          Keeping in mind that this paper does not deal with specificity or sensitivity figures, it is suggested that in rural and remote settings anaemia is still invisible and point of care testing may have a place to identify it.

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          Most cited references 17

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          Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia.

          Clinicians frequently identify anemia in their older patients, but national data on the prevalence and causes of anemia in this population in the United States have been unavailable. Data presented here are from the noninstitutionalized US population assessed in the third National Health and Nutrition Examination Survey (1988-1994). Anemia was defined by World Health Organization criteria; causes of anemia included iron, folate, and B(12) deficiencies, renal insufficiency, anemia of chronic inflammation (ACI), formerly termed anemia of chronic disease, and unexplained anemia (UA). ACI by definition required normal iron stores with low circulating iron (less than 60 microg/dL). After age 50 years, anemia prevalence rates rose rapidly, to a rate greater than 20% at age 85 and older. Overall, 11.0% of men and 10.2% of women 65 years and older were anemic. Of older persons with anemia, evidence of nutrient deficiency was present in one third, ACI or chronic renal disease or both was present in one third, and UA was present in one third. Most occurrences of anemia were mild; 2.8% of women and 1.6% of men had hemoglobin levels lower than 110 g/L (11 g/dL). Therefore, anemia is common, albeit not severe, in the older population, and a substantial proportion of anemia is of indeterminate cause. The impact of anemia on quality of life, recovery from illness, and functional abilities must be further investigated in older persons.
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            Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia.

            Idiopathic iron-deficiency anemia in adults is assumed to be the result of occult chronic blood loss from the gastrointestinal tract. The aim of this study was to determine an effective clinical strategy for managing this common clinical problem. We prospectively studied 100 consecutive patients with iron-deficiency anemia, using colonoscopy and esophagogastroduodenoscopy and, in patients with negative endoscopic studies, enteroclysis (radio-graphic examination of the small intestine). Gastrointestinal endoscopy revealed at least one lesion potentially responsible for blood loss in 62 of the 100 patients. Endoscopic examination of the upper gastrointestinal tract showed a bleeding source in 36 patients, and colonoscopy showed a lesion in 25; 1 patient had lesions in both the upper and lower gastrointestinal tracts. The most common abnormality in the upper gastrointestinal tract was peptic ulceration (duodenal ulcer in 11 patients, gastric ulcer in 5, and anastomotic ulcer in 3). Cancers, detected in 11 patients, were the most common colonic lesions. Enteroclysis was performed in 26 of the 38 patients with negative endoscopic studies, and the results were normal in all instances. Symptoms at a specific site in the gastrointestinal tract were predictive of disease in the corresponding portion of the bowel. In addition, the combination of positive tests for fecal occult blood and symptoms in the lower gastrointestinal tract had a positive predictive value of 86 percent for detecting a lesion in the lower gastrointestinal tract. Gastrointestinal lesions (in both the upper gastrointestinal tract and the colon) are frequently found in patients with iron-deficiency anemia. Since site-specific symptoms are predictive of abnormalities in the corresponding portion of the bowel, the initial evaluation should be directed by the location of the symptoms. Concomitant lesions of the upper and lower gastrointestinal tract are rare; thus, detection of a likely source of blood loss during the initial examination may obviate the need for further procedures.
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              Prospective evaluation of gastrointestinal tract in patients with iron-deficiency anemia.

               T Kepczyk,  S Kadakia (1995)
              Gastrointestinal bleeding is believed to cause iron-deficiency anemia (IDA). The information concerning ideal evaluation of the gastrointestinal tract and exact findings in patients with IDA is scant. The aim of this study was to prospectively evaluate patients with IDA for gastrointestinal lesions potentially causing IDA at a US Army Teaching Medical Center with Gastroenterology Fellowship. Seventy patients with IDA had esophagogastroduodenoscopy (EGD) and colonoscopy, and if this evaluation was unremarkable, then small bowel biopsy was obtained at EGD to evaluate for celiac disease. Enteroclysis was done if endoscopic evaluation was negative. At endoscopy, at least one lesion potentially accounted for the IDA in 50 (71%) patients. At colonoscopy, 21 (30%) patients had 22 lesions (four colon cancer, seven adenoma > 1 cm, six vascular malformation, four severely bleeding hemorrhoids, one ileal Crohn's); at EGD, 39 (56%) patients had 43 lesions (11 gastric erosion, 10 esophagitis, four vascular malformation, four celiac disease, three gastric cancer, three gastric ulcer, three duodenal ulcer, two gastric polyp > 1 cm, one duodenal lymphoma, one esophageal cancer, and one duodenal Crohn's). Twelve (17%) patients had both upper and lower gastrointestinal tract lesions. Twenty-four of 32 (75%) patients with positive fecal occult blood test had potentially bleeding lesions compared to 24 of 38 (63%) patients with negative fecal occult blood test (P > 0.05). Six of nine patients with malignancy had positive fecal occult blood test. Twenty patients with normal endoscopy and small bowel biopsy had normal enteroclysis.(ABSTRACT TRUNCATED AT 250 WORDS)
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                Author and article information

                Journal
                Asia Pac Fam Med
                Asia Pac Fam Med
                Asia Pacific Family Medicine
                BioMed Central
                1444-1683
                1447-056X
                2012
                25 April 2012
                : 11
                : 1
                : 4
                Affiliations
                [1 ]Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
                [2 ]Research-based network of General Practice in Crete, Heraklion, Greece
                [3 ]Spili Primary Health Care Centre, Spili, Rethymno, Crete, Greece
                [4 ]Charakas Primary Health Care Centre, Charakas, Heraklion, Crete, Greece
                Article
                1447-056X-11-4
                10.1186/1447-056X-11-4
                3353223
                22533879
                Copyright ©2012 Lionis et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Research

                Medicine

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