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home - Miscellaneous - Bleeding - Iron Deficiency Anaemia Written by Dr Sebastian Zeki

Iron Deficiency Anaemia

FOB Positives and Iron deficiency anaemia Yield of evaluating the lower digestive tract —Evaluation should start with the colon.PPV for a FOB test predicting colon cancer ranged from 0.9 to 18.7 %.Yield of evaluating the upper digestive tract —Upper GI blood loss can cause positive FOB's- up to 15% have an upper GI bleeding source if negative colonoscopy for positive FOB's15% have upper and lower tract lesions Small bowel sources of bleeding:Angiodysplasias- most common.Tumours of the small intestine (primary benign or malignant tumors or metastatic lesions).Small bowel ulcers (which can be caused by nonsteroidal antiinflammatory drugs).Aortoenteric fistulas.Diverticula.Endometriosis.Haemobilia. Guaiac based testing —Guaiac turns blue when exposed to the pseudoperoxidase activity of hemoglobin in the presence of O2.Need faecal blood loss >10 mL/ day (10 mg/g stool) for test to be +ve 50 % of the time.The test is most sensitive for detecting large, distal colonic lesions.False +ve results with ingestion of red meat and dietary peroxidases (found in turnips and radishes). Vitamin C can lead to false -ve results.By contrast, oral iron supplements do not result in a false positive result.Method of obtaining or developing the stool sampleDont use DRE to get FOBRehydration of stool Hemoccult cards —Increases sensitivity, but sacrifices specificity.Immunologic and fluorometric assays —Detect as little as 0.3 mg/g of Hb Evidence of iron deficiency-Low ferritin-Microcytosis-Hypochromia If not Anaemic and young (<50) then give iron replacement and if resolves, no further investigation needed Anaemic and/or >50 then check coeliac serology, if negative then... If premenopausal and no FH or other symptomsOtherwise OGD and colonoscopy Testing for Occult Blood Small bowel evaluation is recommended for patients with occult gastrointestinal blood loss and iron deficiency anemia who had negative upper and lower endosc-pies.Small bowel evaluation is not recommended for patients with occult gastrointesti-nal blood loss who are asymptomatic and who do not have iron deficiency anaemia. Evaluation Of Positive FOB’s Written by Dr Sebastian Zeki

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