Volume 200 - Issue 1
Investigating iron deficiency anaemia
Authors: William Sievert, Barbara A Leggett and Finlay A Macrae
Med J Aust 2014; 200 (1): 18-20. || doi: 10.5694/mja13.11201
Published online: 20 January 2014
Published online: 20 January 2014
In reply: We appreciate the interest of Bolin and Williams regarding our article.1 We agree that further investigation of iron deficiency anaemia was indicated in this patient, as her clinical presentation of severe, unexplained anaemia is clearly articulated in the Gastroenterological Society of Australia recommendations as requiring such diagnostic investigation, as stated in our article. Colonoscopy would have been the most appropriate investigation. Williams states ...
In reply: We appreciate the interest of Bolin and Williams regarding our article.1 We agree that further investigation of iron deficiency anaemia was indicated in this patient, as her clinical presentation of severe, unexplained anaemia is clearly articulated in the Gastroenterological Society of Australia recommendations as requiring such diagnostic investigation, as stated in our article. Colonoscopy would have been the most appropriate investigation. Williams states that all adults with significant iron deficiency anaemia should undergo endoscopy and colonoscopy. While no one would argue that the young woman did not have significant anaemia, there is no agreed definition of what is, or is not, significant. Given the common occurrence of iron deficiency in premenopausal women, prudent physicians and surgeons must consider the necessity for further investigation in each individual, given that dietary deficiency or menstrual loss are much more common than colorectal cancer in young women. This does not mean that young anaemic women should never undergo endoscopy or colonoscopy; it means that clinical judgement, including thorough history-taking, is required in the decision-making process.
While faecal occult blood testing has no role as a primary diagnostic test for gastrointestinal bleeding, it has a proven, evidence-based role in population screening for colorectal cancer. Williams notes the Gastroenterological Society recommendation for colonoscopy following a positive faecal occult blood test. In this situation, clinicians should consider each patient’s individual risk–benefit profile for colonoscopy before proceeding with the procedure.
In regard to the change in colorectal cancer incidence2 referred to by Bolin, we note that the absolute increase in the age range of the young woman in our article (20–24-year-olds) was low: 0.6 per 100 000 in 1987 to 1.5 per 100 000 in 2006.
Competing interests
No relevant disclosures.
References
- Sievert W, Macrae FA, Leggett BA; Gastroenterological Society of Australia. Investigating iron deficiency anaemia. Med J Aust 2013; 198: 563. 0_CHDJCCII
- Davis DM, Marcet JE, Frattini JC, et al. Is it time to lower the recommended screening age for colorectal cancer? J Am Coll Surg 2011; 213: 352-361. 0_pgfId-2965075