PTH-144 Anaemia of Chronic Disease: High Malignancy Yield

Abstract

Introduction Anaemia of chronic disease (ACD) is said to be associated with prolonged inflammation or infection, or malignancy. We sought to determine the yield of investigations in a cohort of patients referred to the outpatient clinic with blood tests compatible with ACD. Methods We prospectively collected data on patients attending a single consultant led iron-deficiency anaemia (IDA) clinic, who did not fulfil the criteria for iron deficiency anaemia, from 2013–2015. These patients were investigated according to symptoms and blood tests by a single consultant physician. Results A total of 371 patients were referred with the label of IDA. Iron deficiency anaemia was confirmed in 282 patients, and isolated iron deficiency in a further 11 patients, leaving 78 (21%) who did not fulfil the criteria and were deemed to have ACD (age range 45–92; 53 males). Thirty two (41%) were asymptomatic. Malignancy was discovered in 11 (14%) (colorectal 2, lung 2, prostate 2, combined gastric and colonic 1, gastric 1, renal 1, cervical 1, lymphoma 1). Three of the 11 patients with malignancy were asymptomatic (2 lung, 1 colonic). The majority (9/11) were evident on CT scanning of the chest, abdomen and pelvis. Other diagnoses responsible for ACD (23) were: chronic kidney disease (CKD) 7, haemoglobinopathy 3 (with associated CKD in 1), MGUS 3, myelodysplastic syndrome 2, low B12 2 (metformin in 1), haematoma 1, haemorrhagic gastritis 1, menorrhagia 1, pernicious anaemia 1, polymyalgia rheumatica 1, seronegative coeliac disease 1. No cause for the anaemia was found in 43 (56%) of the cohort. Conclusion The prevalence of malignancy in ACD is high. Cross-sectional imaging as a first line investigation will pick up the majority of malignancies. CKD is a common cause of ACD. No cause of ACD is found in over half of patients. Disclosure of Interest None Declared