Open questions and misconceptions in the diagnosis and management of anemia in patients with gastrointestinal bleeding

Gastroenterol Hepatol. 2018 Jan;41(1):63-76. doi: 10.1016/j.gastrohep.2017.08.012. Epub 2017 Oct 27.
[Article in English, Spanish]

Abstract

Despite high prevalence of iron deficiency anemia (IDA) in patients with acute or chronic gastrointestinal bleeding (GIB), IDA and iron deficiency (ID) are frequently untreated. Reasons may be misconceptions about the impact and diagnosis of IDA and the efficacy of new treatments. Addressing these misconceptions, this article summarizes current evidence for better understanding and management of GIB-associated IDA. Despite only few controlled studies evaluated the efficacy of iron treatment in patients with GIB, there is consistent evidence suggesting that: (a) IDA should be diligently investigated, (b) effective treatment of ID/IDA improves outcomes such as health-related quality of life and can avoid severe cardiovascular consequences, and (c) intravenous iron should be considered as well-tolerated treatment in this setting. Overall, the misconceptions and practices outlined in this article should be replaced with strategies that are more in line with current guidelines and best practice in GIB and other underlying conditions of ID/IDA.

Keywords: Anemia; Diagnosis; Diagnóstico; Gastrointestinal bleeding; Hemorragia digestiva; Hierro; Iron; Tratamientos; Treatments.

Publication types

  • Review

MeSH terms

  • Anemia, Iron-Deficiency / diagnosis
  • Anemia, Iron-Deficiency / drug therapy
  • Anemia, Iron-Deficiency / epidemiology
  • Anemia, Iron-Deficiency / etiology*
  • Cardiovascular Diseases / prevention & control
  • Delayed Diagnosis
  • Disease Management
  • Drug Monitoring / standards
  • Ferritins / blood
  • Gastrointestinal Hemorrhage / complications*
  • Gastrointestinal Hemorrhage / diagnosis
  • Gastrointestinal Hemorrhage / therapy
  • Hemoglobins / analysis
  • Hospitalization
  • Humans
  • Infusions, Intravenous
  • Iron / administration & dosage
  • Iron / therapeutic use
  • Iron Deficiencies
  • Practice Guidelines as Topic
  • Prevalence
  • Quality of Life

Substances

  • Hemoglobins
  • Ferritins
  • Iron