A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases

Abstract

Iron deficiency (ID), with or without anemia, is often caused by digestive diseases and should always be investigated, except in very specific situations, as its causes could be serious diseases, such as cancer. Diagnosis of ID is not always easy. Low serum levels of ferritin or transferrin saturation, imply a situation of absolute or functional ID. It is sometimes difficult to differentiate ID anemia from anemia of chronic diseases, which can coexist. In this case, other parameters, such as soluble transferrin receptor activity can be very useful. After an initial evaluation by clinical history, urine analysis, and serological tests for celiac disease, gastroscopy and colonoscopy are the key diagnostic tools for investigating the origin of ID, and will detect the most important and prevalent diseases. If both tests are normal and anemia is not severe, treatment with oral iron can be indicated, along with stopping any treatment with non-steroidal anti-inflammatory drugs. In the absence of response to oral iron, or if the anemia is severe or clinical suspicion of important disease persists, we must insist on diagnostic evaluation. Repeat endoscopic studies should be considered in many cases and if both still show normal results, investigating the small bowel must be considered. The main techniques in this case are capsule endoscopy, followed by enteroscopy.

Demir eksikliği anemisi olan hastalarda alt ve üst gastrointestinal endoskopik inceleme sonuçları

“…Bu nedenle bu hastalara üst endoskopik incelemede antral ve fundus biyopsisi ile duodenal biyopsi yapılmalıdır. Yapılan çalışmalarda DEA'sı olanlarda çölyak prevelansı %3-15, atrofik gastrit prevalansı %20-27 olarak gösterilmiştir (23,24). Bizim çalışmamızda da çölyak hastalığı %2,8 ve atrofik gastrit %10 oranında bulunmuştur.…”

Altered Hematological and Biochemical Parameters in Schoolchildren Living in an Agricultural Community of Merida State, Venezuela

“…Based on RBC parameters, the mean Hb level of the farm children was within the normal limits; moreover, all detected levels were above the established cut-off levels for anemia (˂11.5 g/dL) for this age group (WHO, 2001), indicating that these children were not anemic. Conversely, iron deficiency can occur with normal Hb levels and patients often show relatively few symptoms spontaneously [57]. Iron deficiency in children can affect development and lead to anemia; untreated iron deficiency can cause physical and mental delays and increases susceptibility to infections [60,61].…”

“…Conversely, iron deficiency can occur with normal Hb levels and patients often show relatively few symptoms spontaneously [57]. Iron deficiency in children can affect development and lead to anemia; untreated iron deficiency can cause physical and mental delays and increases susceptibility to infections [60,61]. However, due to fund limitations, assay of micronutrient deficiency indicators, such as serum ferritin and transferrin, were not included in the study.…”

“…Iron deficiency is most commonly associated with thrombocytosis [57,58]. Elevated platelet counts, especially in the setting of iron deficiency, can lead to an increased thromboembolic risk, with clinical consequences especially in patients with inflammatory bowel disease, chronic kidney disease or cancer [59].…”

Deficiencia de micronutrientes y enfermedad celíaca en pediatría

“…La anemia nutricional es más común en celíacos; se manifiesta como anemia microcítica, hipocrómica, con concentraciones bajas de Fe sérico, elevación de la capacidad total de ligar Fe y bajas concentraciones de ferritina sérica. 10 D i v e r s o s e s t u d i o s h a n r e p o r t a d o u n a incidencia de anemia por déficit de Fe en pacientes con EC subclínica de 46-50%; su prevalencia es mayor en adultos. A su vez, en pacientes con anemia por déficit de Fe refractaria al tratamiento, se encontró una incidencia de EC de entre 8 y 20% y, en adultos noruegos donantes de sangre, de 5,2%.…”