title: Referral of patients with iron deficiency anaemia under the lower gastrointestinal two-week wait rule.
abstract: OBJECTIVE
  One of the 2-week wait (2WW) criteria for suspected lower gastrointestinal cancer states that patients should be referred who have iron deficiency anaemia (IDA) without obvious cause [Haemoglobin (Hb) <11 g/dl men, <10 g/dl postmenopausal women].
  
  
  OBJECTIVE
  Our aim was to find the proportion of patients referred as a 2WW not meeting the criteria, and the cost accrued by unnecessary referral.
  
  
  METHODS
  Patients referred over 1 year were identified using the hospitals cancer database. Haematology, haematinics, coeliac serology and cancer status were recorded for each patient.
  
  
  RESULTS
  A total of 204 patients were referred. In total, only 22/204 patients (10.8%) met all the necessary criteria for diagnosis and investigation of IDA prior to referral. As only 43/204 (21.1%) had been assessed for coeliac serology, this accounted for the majority of incomplete referrals. Excluding coeliac serology, only 127 (62.3%) met 2WW criteria for IDA. Of the remaining 77 patients, 57 (74%) patients did not meet the 2WW criteria on Hb alone and 35/77 were referred with no evidence of IDA. 12/127 (9.4%) patients were diagnosed with colorectal cancer. No cancers were detected in patients without BSG evidence of IDA, although one patient did not meet the criteria on Hb level alone.
  
  
  CONCLUSIONS
  Although iron deficiency is a good marker for gastrointestinal cancer, it is evident that 2WW referral guidelines are not being followed. 89.2% of referrals are inappropriate according to guidelines. This not only has considerable workload and financial implications but could be potentially detrimental to patient health.
authors.affiliation: Department of Colorectal Surgery, Derby City General Hospital, Derby, UK. drshaw@doctors.net.uk
authors.forename: A G
authors.initials: AG
authors.lastname: Shaw
authors.forename: J
authors.initials: J
authors.lastname: Simpson
authors.forename: G
authors.initials: G
authors.lastname: Tierney
authors.forename: A F
authors.initials: AF
authors.lastname: Goddard
authors.forename: J R
authors.initials: JR
authors.lastname: Reynolds
authors.forename: J N
authors.initials: JN
authors.lastname: Lund
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000175:diagnosis*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016099:Endoscopy, Gastrointestinal / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data*; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors; D006113:United Kingdom; D019564:Unnecessary Procedures / Q000191:economics* / Q000706:statistics & numerical data; D014850:Waiting Lists