Hépato-Gastro & Oncologie Digestive


Work up of iron deficiency anemia Volume 21, issue 9, Novembre 2014


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Hôpital Européen Georges Pompidou,
service d’hépato-gastroentérologie et d’endoscopie digestive,
20 rue Leblanc,
75015 Paris
* Tirés à part

Iron deficiency anaemia affects 15 to 30% of the world population and has a prevalence of 2-5% among adult men and post-menopausal women in the developed world. The serum or plasma ferritin concentration is an excellent indicator of iron stores whereas serum iron level is less informative. Chronic gastrointestinal blood loss is the main cause of iron deficiency anemia in men and post-menopausal women, whereas gynaecological bleeding is the major cause in young women. Primary work up of digestive iron deficiency anemia includes upper and lower gastrointestinal endoscopy in subjects over 40 years, and only upper gastrointestinal endoscopy in young subjects and pre-menopausal women. Occult gastrointestinal bleeding should be suspected after a first negative upper and lower gastrointestinal endoscopy and capsule endoscopy should be offered after ruling out a small bowel stricture. This test can identify the cause of occult gastrointestinal bleeding such as angiodysplasia, small bowel ulcers and tumors. If anemia persists despite iron replacement therapy after a first negative work up, upper and lower gastrointestinal endoscopies should be repeated in an optimal setting. Oral iron replacement therapy is the first step in symptomatic treatment of iron deficiency anemia. Angiodysplasia are best treated endoscopically with argon plasma coagulation. If endoscopic therapy fails, pharmacologic therapy with somatostatine analogues or thalidomide can be effective.