title: Patients over 45 years with iron deficiency require investigation.
abstract: BACKGROUND
  Iron deficiency anaemia (IDA) that occurs in patients above the age of 45 years is often caused by gastrointestinal blood loss, and guidelines on the appropriate investigation of these patients have been published. There are few data regarding patients with iron deficiency who are not anaemic and it is not clear how these patients should be managed.
  
  
  OBJECTIVE
  We set out to investigate the hypothesis that similar pathologies are likely to underlie iron deficiency and IDA, and to assess whether IDA was being investigated according to the guidelines published by the British Society of Gastroenterology (BSG).
  
  
  METHODS
  The pathology computer identified 153 consecutive patients over the age of 45 years who had serum ferritin levels below 20 microg/dl (normal range 20-200 microg/dl) in a 2 month period (i.e., October and November 2000). Medical records were examined and we recorded all investigations, the diagnoses reached, and the investigating specialty. The results were compared using odds ratios (ORs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  The study shows that the causes of iron deficiency and IDA are similar, but IDA is investigated more thoroughly than iron deficiency, OR 2.07 (CI 1.08-3.97). Ten patients with iron deficiency without anaemia were found to have coeliac disease, a significant result, OR 6.71 (CI 1.38-32.6). The majority of patients with IDA are not under the care of a gastroenterologist and this group are significantly less likely to be investigated according to the BSG guidelines, OR 0.15 (0.04-0.6).
  
  
  CONCLUSIONS
  The study shows that the yield of investigation of iron deficiency is high and, hence, it should be investigated in all patients over the age of 45 years. Despite guidelines published by the BSG, IDA is investigated sub-optimally and measures other than the issuing of guidelines are needed to change practice.
authors.affiliation: Department of Gastroenterology, Bristol Royal Infirmary, Marlborough Street, UK.
authors.forename: Trevor N
authors.initials: TN
authors.lastname: Brooklyn
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Di Mambro
authors.forename: Neil
authors.initials: N
authors.lastname: Haslam
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology*; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis; D005260:Female; D005293:Ferritins / Q000097:blood; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis; D019983:Guideline Adherence; D006801:Humans; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic
chemical_list: D005293:Ferritins