Audit
Audit of the investigation of iron deficiency anaemia in a
district general hospital, with sample guidelines for future practice
J M T Willoughby, S M Laitner
Department of
Medicine, Lister Hospital, Stevenage, Herts SG1 4AB, UK
Correspondence to: Dr Willoughby
Submitted 1
June 1999;
Accepted 13 August 1999
Iron deficiency anaemia commonly presents in patients who are
asymptomatic. In the absence of published guidelines the search for a
cause in such cases is frequently uncoordinated, and risks delay in the
diagnosis of pathologies requiring urgent attention. This audit was
undertaken to determine how thoroughly patients referred to the
gastrointestinal unit in a district general hospital between 1990 and
1995 had been investigated, and to draw up guidelines for future
practice on the basis of its results. From the case notes of 334 patients examined endoscopically for anaemia 126 were identified as
having both proved iron deficiency and a lack of clinical pointers to
its cause. The percentage and details of diagnoses made during initial
study and a median follow up period of 28 months were ascertained,
together with the certified diagnoses of patients who had died. A cause
of iron deficiency was identified in 48 (38%) of patients, 22 with
cancer. Ten others received a diagnosis during follow up, of whom three
died from the condition to which their anaemia had been attributed.
Death certificates supplied diagnoses of potential relevance in three further cases. The main gaps in endoscopic coverage consisted of
omitting duodenal biopsy or colonoscopy after negative upper gastrointestinal endoscopy. Moreover, diagnosis of certain
extraintestinal pathologies, including cancers, was sometimes delayed
for lack of liaison between gastroenterologists and other specialists. These and other points have been addressed in the guidelines now proposed.
Keywords: audit; investigation; iron deficiency anaemia; guidelines
© 2000 by The Fellowship of Postgraduate Medicine
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