EP-180 Analysis of two-week wait referrals to a colorectal surgery department for iron deficiency anaemia in a rural DGH

Abstract

Abstract Iron deficiency anaemia (IDA), defined as low haemoglobin and ferritin levels, affects 2–5% of adults in the developed world. Asymptomatic malignant gastrointestinal pathology must be excluded in all patients. Patients referred on a two-week wait Colorectal pathway with IDA between 4/1/2018–28/2/2021 were recruited (n=566). 92.4% of patients were investigated, only 45.2% had true IDA. Although screening for coeliac disease was a prerequisite in the referral pro forma, 63.2% were referred without. NICE guidance recommends upper and lower gastrointestinal investigations in all patients with confirmed IDA. 61.6% of patients had both investigations performed. 65.1% patients were diagnosed with benign conditions- diverticular disease (37.6%), polyp (31%) and hiatus hernia (28.5%). Age was the strongest predictor for pathology in patients with IDA (p=0.001), not specifically for cancer (p=0.111). 4.4% (n=23) patients were diagnosed with colorectal cancer. Low haemoglobin was significantly correlated with cancer (p=0.002), however only 60.9% had low ferritin. Guidelines suggest that only post-menopausal women should be investigated for IDA unless symptomatic or risk factors. Although only 80% had symptoms; the entire cohort had investigations and only 60% returned a positive test. This study highlighted variability in investigations in addition to lack of adherence by primary care physicians to referral guidelines resulting in avoidable referrals and potentially inappropriate investigations in pre-menopausal women by secondary care physicians, thus overwhelming an exceedingly burdened two- week wait pathway.