Diagnostics in anaemia of chronic disease in general practice: a real-world retrospective cohort study.

Annemarie Schop,Mark-David Levin,Joost Van Rosmalen,Patrick Je Bindels,Ron Van Houten,Jürgen Riedl,Karlijn Stouten

doi:10.3399/bjgpopen18x101597

Annemarie Schop, Mark-David Levin + Show 5 more

Open Access

https://doi.org/10.3399/bjgpopen18x101597

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Abstract

BackgroundLimited research has been performed that focused on the diagnosis of the underlying cause of anaemia of chronic disease (ACD) in general practice or on prevalence data of the underlying causes of ACD in general practice, although this is one of the most common types of anaemia.AimTo clarify the diagnostic strategies of GPs in patients newly diagnosed with ACD and to determine the most common underlying causes.Design & settingRetrospective cohort study.MethodPatients newly diagnosed with ACD were selected based on laboratory criteria. ACD was defined as confirmed anaemia and ferritin levels above 100 μg/l combined with decreased iron and/or reduced transferrin. Additional medical information on patients was obtained from the electronic medical files of the GP and/or the referral hospital.ResultsOf the 267 analysed patients with ACD, additional investigations were performed in 205 patients (77%); in 31 patients (12%) the cause was apparent at the time of diagnosis, and for 31 patients (12%) no additional investigations were requested. In 210 (79%) of the 267 patients, an underlying cause was established, with infection (n = 68, 32%), autoimmune disease (n = 51, 24%) and malignancy (n = 48, 23%) as the most frequently observed etiologies. In 35 (13%) of the ACD patients, oral iron supplementation was prescribed by the GP. This was mainly done in patients with severe anaemia or less enhanced ferritin levels.ConclusionFor most patients with newly diagnosed ACD, the GP undertakes additional investigations to establish underlying causes. However, the cause of ACD remains unknown in a small proportion of patients. The use of oral iron supplementation in these patients requires caution.

Highlights

Of the 267 analysed patients with anaemia of chronic disease (ACD), additional investigations were performed in 205 patients (77%); in 31 patients (12%) the cause was apparent at the time of diagnosis, and for 31 patients (12%) no additional investigations were requested
In 35 (13%) of the ACD patients, oral iron supplementation was prescribed by the GP
This study provides an overview of the most commonly requested additional investigations by GPs and presents the prevalence of the most common underlying causes of ACD in general practice

Summary

Introduction

ACD is described as a functional iron deficiency caused by elevated hepcidin levels, which implies that oral iron supplementation is unnecessary.[14,15,16] Patients with ACD aged 50 years have a relative risk for mortality of 1.48 compared to adults without anaemia.[17] To ensure proper treatment of ACD, the underlying cause needs to be elucidated and treated. If the cause is not clear, additional investigations are required.[2,5,15,16,18,19] These steps require active participation of the GPs involved with patients with ACD in general practice. Limited research has been performed that focused on the diagnosis of the underlying cause of anaemia of chronic disease (ACD) in general practice or on prevalence data of the underlying causes of ACD in general practice, this is one of the most common types of anaemia

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