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Which Anemic Patients Should Be Referred for Colonoscopy?

Summary and Comment |
January 25, 2007

Which Anemic Patients Should Be Referred for Colonoscopy?

  1. Allan S. Brett, MD

Serum ferritin of 100 ng/mL or less is a reasonable indicator for prompt colonoscopy among men with unexplained anemia.

  1. Allan S. Brett, MD

Older patients with unexplained anemia are often referred for colonoscopy as a first step, but that practice makes sense only when the anemia is caused by iron deficiency. This issue is complicated further by difficulty in distinguishing between the anemias of iron deficiency and chronic disease, both of which affect serum ferritin.

Researchers at the Minneapolis VA Hospital retrospectively compared four groups of patients (nearly all men; mean age, 69) who were referred for colonoscopy — 414 anemic patients, stratified by serum ferritin level into three groups, and a group of 323 nonanemic patients undergoing screening colonoscopy. Anemic patients with abdominal symptoms, documented gastrointestinal bleeding, or no available ferritin levels were excluded.

The prevalences of advanced colonic neoplasia (high-grade dysplastic or malignant polyp, or invasive cancer) in patients with serum ferritin <50 ng/mL, 51 to 100 ng/mL, and >100 ng/mL were 7.9%, 7.2%, and 1.7%, respectively. The prevalence in the nonanemic screening group was 1.2%. Adding other parameters (e.g., iron saturation, mean cell volume) to a statistical model did not improve predictive accuracy beyond that of ferritin alone.

Comment

In this study, the prevalence of advanced colonic neoplasia among men with ferritin >100 ng/mL was similar to the prevalence in a nonanemic screening population. Thus, serum ferritin of 100 ng/mL or lower is a reasonable indicator for prompt colonoscopy among men with unexplained anemia. Because this was a retrospective study of a selected cohort, clinicians should use this cutoff as a rule of thumb and not as a rigid guideline.

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