Cause Of Iron Deficiency Anemia Research Articles

Management of Severe Iron Deficiency Anemia in the Pediatric Emergency Department: A Comparison of IV Iron Vs Transfusions

▪Introduction: Severe iron deficiency anemia (IDA) is a problem that often presents to the pediatric emergency department (ED). Recently published ASH-ASPHO Choosing Wisely recommendations suggest avoidance of transfusion in hemodynamically stable, asymptomatic children with IDA 1. Little is known about the use of parenteral iron in this pediatric setting.Methods: We undertook a retrospective review of patients with severe IDA treated in the pediatric ED at the Children's Hospital of Eastern Ontario (CHEO) from September 2017 to June 2021. During this period there were an estimated 75000 patients seen annually. Patients with severe IDA were defined as those presenting with hemoglobin (Hb) less than <70 g/L and low mean corpuscular volume.Results: There were 56 patients that met this criterion with presenting Hb ranging from 17-69 g/L (IQR 41- 62). Median age at presentation was 3.75 yrs (IQR 1.68- 15.5), with a bimodal peak at age 1 yr and again in the teen years (Fig 1). 42 (75%) patients were female. The most common causes of IDA were nutritional and heavy menstrual bleeding. 14 (24.6%) received packed red blood cell (PRBC) transfusion with or without parenteral iron (iron sucrose), and 11 (19.3%) were treated with parenteral iron alone. Almost all (55, 98.2%) were prescribed oral iron supplementation. The lower the presenting Hb, the more likely that transfusion or parenteral iron was used as initial therapy (Fig 2). 19 (33.9%) patients were admitted to hospital and 37 (66.1%) were discharged home from the ED. Nine recipients of parenteral iron alone had follow-up at CHEO, six had follow-up within 10 days with Hb increases of at least 20 g/L and all nine patients had follow-up by day 41 showing increases ranging from 20-97 g/L. Three recipients of parenteral iron alone had presenting Hb <30 g/L and by 9 days following ED encounter all three had increased their Hb by at least 20 (20-32) g/L. Three patients were discharged from ED after IV iron, and none presented to the ED again. Six recipients of PRBCs had follow up within 10 days showing Hb increase ranging from 33-62 g/L, only five had follow-up by day 41 showing increases of 42-79 g/L. Five patients received >1 transfusion, and transfused volumes ranged from 5-25 mL/kg. Minor infusion reactions occurred in 2 (17%) recipients of parenteral iron, and no patient was suspected to have anaphylaxis. Four (28.5%) patients experienced minor transfusion reactions to packed cells. One recipient of multiple PRBC transfusions had transfusion-associated cardiac overload (TACO) requiring ICU admission.Conclusions: This study demonstrates that patients with severe IDA can be safely and effectively managed in the ED setting with parenteral iron therapy alone without PRBC transfusion. The use of parenteral iron avoids the potential short and long-term complications associated with transfusion, whilst ensuring rapid restoration of iron stores without the tolerability issues associated with oral iron. [Display omitted] DisclosuresNo relevant conflicts of interest to declare. OffLabel Disclosure:IV iron sucrose is indicated for treatment of iron deficiency in patients 2 and older with CKD. The use of it outside of this context would be considered off label.

Congenital paraesophageal hernia presenting with chronic vomiting and iron deficiency anemia

Hiatal hernia (HH) is very rare in children and is mostly due to congenital defects unlike adults having acquired etiology. HH is either sliding or paraesophageal hernia (PEH). PEH is rarer than sliding type and usually presents with non-specific intestinal or respiratory symptoms. PEH is very uncommon cause of iron deficiency anemia which is due to chronic blood loss from gastric erosions/ulcer and iron malabsorption. Surgery is mandatory treatment for it to avoid complications. Herein, we present a 23 months old female manifesting as intermittent coffee ground vomiting, abdominal pain and constipation, diagnosed as PEH with iron deficiency anemia.

EP.WE.548The prevalence iron deficiency anaemia in patients with oesophago-gastric cancer

Abstract Aims Blood loss from the gastrointestinal tract is the most common cause of iron deficiency anaemia (IDA) in adult men and post-menopausal women. Up to 10% of patients with IDA have underlying gastrointestinal cancer. The aim of this study was to investigate prevalence of IDA in patients with oesophago-gastric cancer. Methods A retrospective cohort study of all newly diagnosed oesophago-gastric cancers (adenocarcinoma and squamous cell carcinoma) and high grade dysplasia discussed at tertiary multi-disciplinary team meeting between October 2019 and September 2020. Electronic case notes and blood profile at presentation, including ferritin and serum iron level, were analysed. Patients who did not have blood profile within three months of presentation were excluded. Results A total of 349 patients were identified, 12 were excluded due to missing data. 226 (67.1%) were male and the mean age was 69.7 ± 11.7 years. 260 (77.2%) were referred from primary care. After initial investigations, 256 (76.0%) were oesophageal cancer, 248 (73.6%) were adenocarcinoma, and 134 (39.8%) were metastatic at presentation. 128 (38.0%) patients were anaemic: 30 (23.4%) microcytic, 88 (68.8%) normocytic and 10 (7.8%) macrocytic. 98 (76.6%) anaemic patients had ferritin and/or iron levels checked. Analysis of these identified 63 (49.2%) patients with bloods consistent with IDA: 22 (34.9%) microcytic, 40 (63.5%) normocytic, and 1 (1.6%) macrocytic. Conclusions This study confirms that while there is high prevalence of anaemia in patients presenting with oesophagi-gastric cancer, IDA was diagnosed in only half of these. The predominant form of anaemia identified in these patients is normocytic.

1437 Histological Examination in Search of Helicobacter Pylori in Iron Deficiency Anaemia: An Unnecessary Expense?

Abstract Aim The British Society of Gastroenterology guidelines recommend Helicobacter pylori (HP) testing in patients with iron deficiency anaemia (IDA). This quality improvement project evaluates the utility of histological examination for HP in IDA patients, the consequent expenditure and whether a more cost-effective alternative exists. Method A retrospective search was conducted of patients within a four-month period who underwent an oesophago-gastroduodenoscopy (OGD) for IDA. Patients with an identifiable cause of IDA, ferritin &amp;gt;40ug/mL and haemoglobin (Hb) &amp;gt;12g/L in women or &amp;gt; 13g/L in men were excluded. The costings of a single tissue biopsy and HP stool testing were sought from our local departments. Results Ninety-nine patients’ results were analysed after exclusions (n = 99/127, 78.0%). All patients had biopsies taken at OGD. On average, three biopsies were obtained per patient. Forty-two patients had no abnormalities visualized on OGD and all ninety-nine patients were HP negative. A single biopsy costs £70; £65 per hematoxylin and eosin based histological examination and £5 per single-use biopsy forceps. Accounting for forty-two patients with macroscopically normal OGDs leads to a total expenditure of £8820. A HP stool test costs £14. Conclusions Guidelines recommend HP testing either non-invasively or at OGD as an alternative strategy, based on weak evidence that HP may cause IDA. HP prevalence is falling; histological examination of biopsies obtained at OGD therefore appears expensive and unnecessary. It is more cost effective to perform a stool test in the case of a normal OGD and commence treatment accordingly with biopsies reserved when otherwise clinically indicated and not solely for HP testing.

HOSPITAL ADMISSIONS FOR IRON DEFICIENCY ANEMIA IN BRAZIL: EPIDEMIOLOGICAL FINDINGS FROM 2019-2020

Iron deficiency anemia (IDA) is the most common type of anemia, affecting all ages and being even more prevalent in low- and middle-income countries. Most cases are easily treated at an outpatient clinic and do not need hospitalizations. However, the reasons for hospital admissions for IDA may vary, as it has detrimental effects in patients with coronary artery disease, heart failure, and pulmonary hypertension. Furthermore, IDA is a risk factor for maternal and perinatal mortality, and it is related to low productivity and cognitive impairment. For over 20 years, the Brazilian government has promoted public health politics to prevent IDA, especially in children, and pregnant and postpartum women. This study aims to evaluate the epidemiology of hospitalizations for IDA in Brazil during 2019 and 2020. Cross-sectional, descriptive and retrospective study, which evaluated the epidemiology of hospital admissions for IDA in the Brazilian National Health System in the years 2019 and 2020. Hospital admissions were evaluated by sex, geographic region, and age group using the national database (DATASUS – Department of Informatics of the Unified Health System). During this time period, there was a total of 21523 hospitalizations for iron deficiency anemia in the Brazilian National Health System, with 10981 (51%) hospital admissions in 2019 and 10542 (49%) in 2020. Also, 9079 (42.1%) patients were male and 12444 (57.8%) were female. Most of the hospitalizations occurred in the Southeast region (8767; 40.7%), 5409 (25.1%) in the Northeast region, 3861 (17.9%) in the South region, 1797 (8.4%) in the North region, and 1689 (7.9%) in the Central-West region. Regarding age groups; 562 (2.6%) were less than 1 year old, 862 (4%) were 1-9, 832 (3.9%) were 10-19, 2034 (9.5%) were 20-34, 2463 (11.4%) were 35-44, 4127 (19.2%) were 45-59, 3190 (14.8%) were 60-69, 3607 (16.8%) were 70-79, and 3846 (17.8%) were >80 years old. Considering the population size of the geographic regions, the equal relative number of hospitalizations for IDA among the Brazilian regions may suggest that the impact of social factors on iron deficiency – food insecurity and malnutrition – is a minor problem or at least circumvented by public health preventive strategies, like oral iron supplementation and food fortification. This reflects on the low rates for children and teenagers (<1-19), as their main cause of IDA is low iron intake. There is an increase in the reproductive age (20-44), when it presents even more unfavorable to women due to menstruation and gestation. The elderly (>60) has over three times higher rates than those of children and teenagers, and above the average rate for the reproductive age, marking the relevance of chronic causes and a more equal representation of both sexes. The enforcement of public health preventive strategies appears to be the most contributing factor to the low child and teenager hospitalization rates. However, the overall rates for the adult and elderly population suggest that more effective detection and early intervention are required. Health politics regarding regular gynecologist appointments, better prenatal and postnatal care, and cancer screening can help reducing hospitalization for IDA.

Comparative Study on Efficacy of Murvadya Churna with Lauha Bhasma and Navayas Churna in Pandu Roga (Iron Deficiency Anemia)

Pandu Roga is mainly the Rasapradoshaj Vyadhi which vitiates the Pitta. Whereas Shushruta described it as Raktapradoshaj Vyadhi. In Pandu Roga due to Alpa Rakta Twaka Vivarnata (discoloration of skin) occurs.So according to name Panduta is the main feature of Pandu Roga.Due to lack of dietary intake &amp; improper absorption of iron are the causes of Iron deficiency Anemia.&#x0D; Aim: Efficacy of Murvadya Churna with Lauha Bhasma in the management of Pandu Roga (Iron Deficiency Anemia). &#x0D; Material and Methods: Study was contained 60 patients of Pandu were divided into two groups (each group contain 30). In Group A (Experimental group)- Murvadya Churna with Lauha Bhasma 500 mg two times a day after meal with warm water for 30 days &amp; In Group B 500 mg Navayas Lauha was administered two times a day after meal with honey. Assessment was recorded every 15th day (15th &amp; 30th day)&#x0D; Result: Subjective and Objectives outcomes were assessed; both the groups were given equal effects on both the parameters subjective &amp; objective.&#x0D; Conclusion: Murvadya churna with Lauha Bhasma was equally effective as Navayas Lauha.

English

Anemia during pregnancy is a major world health concern especially in developing countries affecting the life of the women and the future of the child thereby influencing the present as well the future of the nation and the world at large. Nutritional deficiency still emerges out the main cause of iron deficiency anemia affecting the life of the pregnant women. The iron deficiency anemia has a major say in adverse pregnancy outcomes like pre term delivery, IUGR, morbidity even leading to mortality, however it is noted that severe anemia has a significant effect than moderate and mild anemia. A well balanced diet can avert this condition, nonetheless iron supplementations as per the government guidelines and various treatment available also help to tackle the situation. Education of the women and more awareness programmes on health, pregnancy and nutrition by the stakeholders can further reduce the incidence of anemia in pregnancy.

Randomized, Double-Blind Trial of Ferumoxytol Compared to Ferric Carboxymaltose for Treatment of Iron Deficiency Anemia: Safety and Efficacy

Background: Intravenous (IV) iron is often used to treat iron deficiency anemia (IDA) in patients unresponsive to, or intolerant of, oral iron. IV iron has been associated with rare, but potentially serious acute hypersensitivity reactions (HSRs). The few randomized trials which assessed comparative risks of adverse events (AEs) with IV iron formulations are limited by small numbers and lack statistical power to identify differences in low frequency AEs such as HSRs. We have attempted to correct this deficit in the literature, by conducting a randomized double-blind clinical trial comparing two IV iron preparations.Aims: To evaluate the comparative safety and efficacy of standard courses of two IV iron preparations, ferumoxytol and ferric carboxymaltose (FCM), with the primary endpoint being the combined incidence of moderate to severe HSRs, including anaphylaxis, or moderate to severe hypotension. A secondary safety endpoint was the composite incidence of moderate to severe HSRs, including anaphylaxis, serious cardiovascular events, or death. Efficacy endpoints included change from baseline in hemoglobin (Hb) and change in Hb per gram of iron administered.Methods: This randomized, double-blind, international, multicenter, trial (NCT02694978) included adults with IDA of any etiology excluding dialysis-dependent CKD (Hb <12.0 g/dL for females; <14.0 g/dL for males and transferrin saturation ≤20% or ferritin ≤100 ng/mL within 60 days of dosing) and a history of unsatisfactory response to or intolerance of oral iron. Randomization was 1:1 to ferumoxytol, administered as two 510 mg doses, or FCM, administered as two 750 mg doses both delivered as an IV infusion over at least 15 minutes on days 1 and 8. Patients were observed for at least 1 hour following the infusions. Follow-up visits were conducted at weeks 2 and 5. All events suggesting possible hypersensitivity or hypotension were reviewed and adjudicated by an expert, independent, blinded Clinical Events Committee (CEC) utilizing pre-specified criteria per protocol. All participants provided written informed consent before enrollment.Results: 2014 patients were randomized at 129 sites in North America (US and Canada) and Eastern Europe (Latvia, Lithuania, Poland, and Hungary). The safety population included the 1997 randomized patients who received any amount of study drug (mean age 55.2 ±17.2 years, 76.1% female, mean baseline values: Hb 10.4 g/dL, transferrin saturation 13.9%, serum ferritin 57.4 ng/mL). The most common underlying causes of IDA included: chronic kidney disease (27%), abnormal uterine bleeding (25%) and gastrointestinal disorders (29%). Ferumoxytol demonstrated non-inferiority (NI) to FCM with respect to both the primary (ferumoxytol rate: 0.6%; FCM rate: 0.7%; treatment difference: -0.1% ; 95% confidence interval: -0.80% to +0.61%) and secondary safety endpoints (ferumoxytol rate: 1.3%; FCM rate: 2.0%; treatment difference: -0.7% ; 95% confidence interval: -1.81% to +0.42%) [TABLE]. Ferumoxytol demonstrated non-inferiority to FCM for both secondary efficacy endpoints (mean change in Hb from Baseline to Week 5, and mean change in Hb from Baseline to Week 5 per gram of iron administered), while additionally demonstrating a significantly greater increase in Hb per gram of iron administered [FIGURE]. Median increase from Baseline to Week 5 in serum ferritin was 182.2 ng/mL for ferumoxytol and 320.5 ng/mL for FCM.Conclusion: While there is little debate as to the efficacy of IV irons on increasing hemoglobin concentrations in patients with IDA, the occurrence of rare but potentially serious acute HSRs continues to be a focus of concern. Very few well conducted trials have compared two or more IV iron formulations by evaluating HSR and hypotension as primary endpoints. In this study there was no significant difference between FCM and ferumoxytol in the composite endpoints of moderate to severe HSR, including anaphylaxis, or moderate to severe hypotension, serious cardiovascular events or all-cause mortality. [Display omitted] DisclosuresAuerbach:AMAG Pharma, Pharmacosmos, Luitpold: Consultancy; AMAG Pharma, Pharmacosmos: Research Funding. Strauss:AMAG pharmaceuticals: Employment, Equity Ownership. Macdougall:AMAG: Consultancy, Honoraria, Research Funding; Pharmacosmos: Honoraria; Vifor Pharma: Consultancy, Honoraria, Research Funding, Speakers Bureau; Akebia: Consultancy; GlaxoSmithKline: Consultancy; Astellas: Honoraria, Research Funding; FibroGen: Consultancy, Speakers Bureau. Bernard:AMAG: Employment. Kaper:AMAG Pharmaceuticals, Inc.: Employment. Chertow:AMAG: Consultancy; Akebia: Consultancy; Amgen: Consultancy, Research Funding; Keryx: Consultancy. Li:AMAG Pharmaceuticals: Employment, Equity Ownership. Trochanov:AMAG Pharmaceutical,Inc: Employment, Other: Company stock. Dahl:AMAG Pharmaceuticals. Inc.: Employment, Equity Ownership. Krop:AMAG Pharmaceuticals: Employment, Other: Stock in company.

Correction of iron deficiency in the clinical picture of internal medicine

Background. The purpose was to theoretically and practically substantiate the existing approaches to the problem of prevalence, causes, clinical manifestations, as well as diagnosis and use of the latest methods of treatment of iron deficiency anemia (IDA) based on studying scientific ideas. Materials and methods. We used systematic analysis, synthesis, and generalization of scientific and medical literature to make it possible to consider modern views on the problem of IDA among different populations in terms of its epidemiology, etiology, presentation of iron metabolism in the body, and pathogenetic mechanisms of clinical and laboratory symptoms as well as modern methods of laboratory diagnosis of anemia and conclusions on a comprehensive approach to the treatment and prevention. Results. The most common blood disease is iron deficiency anemia. Iron deficiency occurs as a result of a mismatch between the body’s needs for iron and its intake or loss. According to the WHO, more than half of the population in different countries suffers from iron deficiency anemia. It covers all age groups but is most common in children, adolescents, and pregnant women. The symptoms of anemia are pale skin, fatigue, dizziness, shortness of breath, loss of consciousness, dysfunction of many organs. The most common causes of iron deficiency anemia are bleeding from wounds or peptic ulcers, hemorrhoidal bleeding, excessive blood loss during menstruation, uterine fibroids, ulcerative colitis, malignant tumors, gastrectomy, and others. In this disease, the iron depot in the body decreases. According to data from domestic and foreign scientists, as well as the WHO, IDA of varying severity is observed in 20 % of the population. The treatment of IDA should first eliminate the cause of bleeding, prescribe a protein-enriched diet, vitamins, and trace elements. In many countries, the prevention and treatment of anemia are becoming a social challenge. The presence of iron deficiency reduces the quality of life of patients, disrupts their ability to work, causes functional disorders of many organs and systems. To prevent and eliminate iron deficiency, a whole group of iron-containing drugs is successfully used, the range of which is constantly replenishing and updating, as well as a comprehensive approach to treatment with modern iron drugs is discussing. Conclusions. The main pathological and physiological conditions that lead to the development of iron deficiency in different population groups are analyzed. Therefore, the treatment of IDA is aimed not only at eliminating anemia as a symptom, but also at eliminating iron deficiency and replenishing its reserves in the body, which can be achieved by taking a liposomal form of iron.

Double-Dose Desogestrel: Is it Effective in Adolescent Menstrual Dysfunction?

Adolescent menstrual dysfunction (AMD) is a common cause of iron deficiency anemia and absences from school. The management of AMD with single- and double-dose desogestrel is largely on the basis of anecdotal evidence. Our aim was to describe the effectiveness and safety of both dosing strategies in our clinic cohort to help guide future management. Local service evaluation with retrospective analysis of clinic notes. Adolescent gynecology clinic in a tertiary pediatric center in the North West of England. Adolescent girls (10-18 years of age) with AMD (n=129). Single-dose (75 µg) desogestrel vs double-dose (150 µg) desogestrel. Prevalence of amenorrhea and light spotting, side effects, and discontinuation rates of both dosing regimens. Forty-three of 87 (49%) adolescent girls who started treatment with a double dose of desogestrel were amenorrheic/experienced light spotting, compared with 7/40 (18%) of girls who started treatment with a single dose (P=.001). Patients taking a double dose of desogestrel were less likely to discontinue overall (double: 45/89 [51%]; vs single: 35/40 [88%]; P < .001) and there was no evidence of an increase in nonbleeding side effects (double: 30/89 [34%]; vs single: 15/40 [38%]; P=.68). Our findings provide evidence that a double dose of desogestrel is associated with a higher prevalence of amenorrhea and light spotting compared with a single dose in adolescent girls with AMD. However, larger studies are needed to further inform clinical guidelines.

Endoscopic findings in the older patients with iron-deficiency anemia

Aim: The presence of iron-deficiency anemia, which is an important indication for endoscopic&#x0D; procedures, in the geriatric population necessitates the exclusion of a possible malignancy in the&#x0D; gastrointestinal system. This study aims to examine endoscopic findings in geriatric patients that&#x0D; underwent esophagogastroduodenoscopy and colonoscopy because of iron-deficiency anemia.&#x0D; Materials and Methods: Sixty patients aged 65 and over who underwent&#x0D; esophagogastroduodenoscopy and colonoscopy because of iron-deficiency anemia between August&#x0D; 2019 and August 2020 were retrospectively evaluated. Age, sex, geriatric age groups of patients,&#x0D; presence of Helicobacter pylori in gastric biopsy, esophagogastroduodenoscopy findings, colonoscopy&#x0D; findings, presence of internal and / or external hemorrhoids, and duodenal biopsy results were&#x0D; examined.&#x0D; Results: Thirty (50%) of 60 patients included in the study were male and the mean age was 72.47 ±&#x0D; 6.07 years. Of these patients, 41 (68.4%) were young-old, 17 (28.3%) were middle-old and 2 (3.3%)&#x0D; were old-old. The most common causes that might explain iron-deficiency anemia in&#x0D; esophagogastroduodenoscopy were atrophic gastritis (21.2%), Helicobacter pylori-positive gastritis&#x0D; (20%), gastric polyp (11.7%), and gastric cancer (3.3%), whereas colonoscopy results were found&#x0D; colon polyps in 23.3% of patients, diverticulum in 15% and angiodysplasia in 15%, and colon cancer in&#x0D; 8.3%. Internal hemorrhoids were also observed in 44 (73.3%) patients.&#x0D; Conclusion: In the older population, blood loss from the gastrointestinal system is the most important&#x0D; cause of iron-deficiency anemia and just hemorrhoids cannot explain IDA. While examining the&#x0D; etiology of patients diagnosed with iron-deficiency anemia, performing both&#x0D; esophagogastroduodenoscopy and colonoscopy is an accurate approach to reach the underlying&#x0D; cause and not to miss a possible malignancy

The prevalence and clinical characteristics of restless legs syndrome in patients with iron deficiency anemia in Korea.

While the prevalence and clinical characteristics of restless legs syndrome (RLS) are known to vary according to ethnicity, a detailed evaluation of this condition among patients with iron deficiency anemia (IDA) has not yet been reported in an Asian population. We investigated the prevalence and clinical characteristics of RLS in patients with IDA in Korea compared with age- and sex-matched patients diagnosed with idiopathic RLS. This prospective single-center study was performed at a regional university hospital. Consecutive patients with IDA were enrolled over a 4-year period. Clinical interviews and laboratory tests were conducted at the first visit. RLS diagnosis was confirmed through face-to-face interviews. We randomly selected patients with idiopathic RLS without comorbid medical disorders from our sleep center dataset as control patients. The clinical characteristics of both groups were compared. We enrolled 124 patients with IDA. Fifty (40.3%) patients were diagnosed with RLS, with 82% exhibiting severe to very severe symptoms. Patients with IDA and RLS were older and reported more sleep deterioration than patients with IDA without RLS. Patients with IDA and RLS also had a more depressed mood and higher periodic limb movement index scores than patients with idiopathic RLS. The prevalence of RLS among patients with IDA in Korea was high, with the majority having severe to very severe symptoms. Patients with IDA and RLS had poorer sleep quality and more emotional problems than patients with IDA without RLS. Therefore, patients with IDA should be screened for RLS to prevent adverse effects on the quality of sleep and life.

Upper and Lower Gastrointestinal Endoscopic Lesions in Patients with Unexplained Iron Deficiency Anaemia- A Cross-sectional Study

Introduction: Anaemia, due to iron deficiency, is very common in India. In many cases, the underlying cause of iron deficiency remains unknown even after detailed laboratory investigations. It is often due to malabsorption of iron from the gut and occult blood loss from the Gastrointestinal (GI) tract. Bidirectional GI endoscopy can help in finding these causes. Aim: To study the upper and lower GI endoscopic lesions in patients with unexplained Iron Deficiency Anaemia (IDA). Materials and Methods: This was a cross-sectional observational study, conducted on 75 patients with unexplained IDA in Dr. DY Patil Medical College and Hospital, Pune, Maharashtra, India, between June 2019 to June 2020. Patients above the age of 18 years and with Haemoglobin (Hb) of less than 13 g/dL (males) and less than 12 g/dL (females) underwent upper GI endoscopy and colonoscopy with biopsies, after ethics committee approval and informed consent. Complete haemogram with blood indices, iron studies and faecal Occult Blood Test (OBT) were conducted for all the patients. The patients were divided into Group A, those with upper/lower GI endoscopy lesions thought to be responsible for IDA and Group B, those without GI endoscopic lesions. Statistical analysis was performed using IBM, Statistical Package for the Social Sciences (SPSS), version 21.0 and statistical tests (Chi-square test, Student’s t-test and multivariate logistic regression analysis, with 95% Confidence Interval (CI) and p-value &lt;0.05 was taken as significant) were used when required. Results: There were 44 females and 31 males in the study, with the age range of 20-81 years. The mean age of patients in Group A (n=44) was 58.57±11.68 years and Group B (n=31) was 49.68±14.45 years. On multivariate analysis, advance age, history of weight loss and faecal occult blood were statistically significantly associated with the presence of GI endoscopic lesions responsible for IDA (p-value&lt;0.05). Maximum lesions responsible for IDA were found in stomach (48%), erosive and inflammatory lesions causing IDA were more common in upper GI tract. Peptic ulcers were found in 12% cases. The GI malignancies were found in 14.66% subjects. Colorectal cancers (8%) were more common than upper GI cancers (6.66%). Conclusion: In patients with IDA, erosive oesophagitis and haemorrhagic gastritis were commonly found followed by peptic ulcers and malignant GI lesions on bidirectional endoscopy. GI endoscopy is a very important tool to diagnose the cause of IDA. All patients with advanced age, history of weight loss and a positive faecal OBT should undergo bidirectional GI endoscopy routinely.

Frequency of iron deficiency anemia (IDA) among patients with Helicobacter pylori infection.

Background and Objective:Helicobacter Pylori (H. pylori) is a widespread infection across the globe having a high prevalence among the developing countries. Iron Deficiency is anticipated to be the most prevalent micronutrient deficiency globally, the most frequent cause of anemia. Our objective was to determine frequency of Iron Deficiency Anemia (IDA) among patients with H. Pylori gastritis.Methods:It was a cross-sectional prospective study. Patients fulfilling inclusion criteria were enrolled at Liaquat National Hospital, Karachi, Pakistan. Blood samples were taken for serum iron, transferrin saturation, ferritin, and total iron-binding capacity and H.pylori assessed by urea breath test, stool for antigen, Rapid urease test or histopathology.Results:112 patients with H. Pylori infection with anemia were included. 53 (47.3%) were males & 59 (52.7%) were females with mean age of 38.4464 ± 9.00634 years. Iron deficiency anemia was seen in 42 patients (37.5%).Conclusion:IDA was noted in 37.5% of cases. H. Pylori infection is a frequent cause of iron-deficiency anemia of previously unidentified origin among adults.

Advancing OB/GYN Knowledge, Competence, and Performance Related to Abnormal Uterine Bleeding and Intravenous Iron Supplementation for Effective Management of Iron Deficiency Anemia: Outcomes Analysis from a 2019 Educational Initiative

Background: Iron deficiency anemia (IDA) is a multifaceted condition associated with immense obstetrical morbidity and mortality, and is especially prevalent in female patients of reproductive age.Abnormal uterine bleeding (AUB), which often manifests clinically as heavy menstrual bleeding (HMB), is the leading cause of IDA among reproductive age women in the United States, with a prevalence ranging from ~30-50% in this patient population; further, HMB is estimated to account for nearly one-third of all IDA causes worldwide. For these reasons, AUB/HMB is generally accepted as the primary causal source of IDA in daily clinical practice.As frontline clinicians who routinely manage HMB, OB/GYNs are optimally positioned to subsequently recognize, diagnose, and treat the IDA precipitated by HMB. However, to ensure the provision of safe and effective care, adaptive educational initiatives with an emphasis on evolving iron supplementation strategies are needed. Methods: Creative Educational Concepts (CEC) conducted a literature review, needs assessment, and detailed gap analysis to identify prominent clinical and educational gaps that exist among OB/GYNs with regard to IDA sign and symptom recognition, epidemiology, clinical gravity and risk factors, formal diagnosis, and appropriate treatment.Consequently, our team at CEC composed a responsive, multi-pronged educational design targeted to obstetricians, gynecologists, and women's health professionals, in a tailored effort to bridge the aforementioned gaps in current practice and improve outcomes for patients.CEC consulted with top experts in obstetrics and gynecology, maternal fetal medicine, pelvic surgery, and hematology at every stage of the educational design and delivery continuum, from proposal ideation to content development to live, on-site presentation.To dynamically engage the target audience, especially at the community, grassroots level, this educational initiative was delivered at a series of five American College of Obstetricians and Gynecologists (ACOG) District Meetings across the United States; live meetings were held in Lake Geneva, WI; San Diego, CA; Kapalua, HI; Rockport, ME; and Manhattan, NY. Results: 203 total clinicians were educated across the initiative Profession MD/DO - 93%APRN/CNM - 3%RN - 2%Other - 2%Specialty General OB/GYN - 81%Maternal/fetal Medicine - 11%Reproductive endocrinology - 4%Pelvic medicine/surgery - 2%Other - 2%&amp;gt;5,000 IDA patients potentially impacted per month as a result of the initiativeStatistically significant advances in learning and knowledge were achieved from pre- to post-activity for all tested educational gaps: Identification of IDA risk factors (85% post vs. 46% pre; P&amp;lt;0.001)Clinical implications of AUB (95% post vs. 74% pre; P&amp;lt;0.001)Appropriate clinical utility of IV iron (93% post vs. 63% pre; P&amp;lt;0.001)Top intended practice changes: Consider IV iron supplementation in my patients with IDA for whom oral iron supplementation is ineffective or intolerableConsider IV iron supplementation as first-line treatment for my patients with severe IDA, ongoing bleeding, and/or absorption deficienciesShare information learned with colleagues and other members of my healthcare teamTop anticipated barriers to change: Limited experience with parenteral iron supplementation therapiesPatient non-adherenceInadequate care coordination between OB/GYNs and primary care physiciansGiven an HMB-associated IDA patient case, activity attendees demonstrated a significant retention of knowledge and clinical performance improvement from pre-test to 4-week follow-up related to appropriate initiation of IV iron 90% at 4-wk follow-up vs. 63% at pre-test (P=0.018) Conclusions: Our 2019 ACOG District Meeting educational initiative precipitated substantive practice advances in knowledge, competence, and performance among OB/GYNs and women's health professionals related to IDA management.Statistically significant performance improvements in appropriate initiation of IV iron for treatment of HMB-associated IDA were achieved at follow-up assessment.Learning and knowledge endpoints for IDA risk factor recognition and AUB clinical implications were not retained with statistical significance at follow-up assessment, thereby evidencing residual educational gaps and a need for ongoing education in this space. Disclosures Shulman: Bayer: Consultancy; AMAG: Speakers Bureau; Lupin: Speakers Bureau; Vermillion: Speakers Bureau. Munro:Vifor: Consultancy; Abbvie: Consultancy, Research Funding; American Regent: Consultancy; Boston Scientific: Consultancy; Daiichi Sankyo: Consultancy. Martin:Daiichi Sankyo: Consultancy. Nelson:Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Bayer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; AMAG: Consultancy; Agile Pharmaceutical: Consultancy, Research Funding; EvoFem: Research Funding; Sebela Pharmaceutica: Consultancy, Research Funding; TherapeuticsMD: Membership on an entity's Board of Directors or advisory committees; American Regent: Consultancy, Membership on an entity's Board of Directors or advisory committees.

Correlation Between Helicobacter Pylori Infection and Iron Deficiency Anemia in School-Aged Children

Background: Iron deficiency anemia (IDA) is recognized as a common nutritional problem in infants and young children in developing countries mainly due to poor nutrition in most cases. Objective: To evaluate the association between H. pylori infection and iron deficiency anemia in school-aged children. Patients and Methods: This study was conducted on 60 participants divided into two groups. Group I: formed of 30 patients suffering from iron deficiency anemia with hemoglobin (Hb) less than l1g/dL. Group II: formed of 30 healthy children (control Group) Results: In the current study we found that there was a significant decrease in weight and BMI among cases group p-value <0.001. In the current study, we found that there was a significant decrease in all CBC parameters among cases versus control. In the current study we found that there were significant differences between the two groups regarding nutritional status as in cases there was a higher percentage of low iron sources in the diet, there was a significant decrease in serum iron, ferritin, and TIBC in cases versus control. In the current study, we found that there was a significant increase in the number of positive samples for H pylori antigen in stool among cases versus control 63.3% versus 23.3% p-value 0.002. Conclusion: The results of this study demonstrate a significant association between children with iron deficiency anemia and positive H. pylori infection in school-age children. Moreover, H. pylori infection may be one of the significant causes of iron deficiency anemia.

Correlation Between Helicobacter Pylori Infection and Iron Deficiency Anemia in School-Aged Children

Background: Iron deficiency anemia (IDA) is recognized as a common nutritional problem in infants and young children in developing countries mainly due to poor nutrition in most cases. Objective: To evaluate the association between H. pylori infection and iron deficiency anemia in school-aged children. Patients and Methods: This study was conducted on 60 participants divided into two groups. Group I: formed of 30 patients suffering from iron deficiency anemia with hemoglobin (Hb) less than l1g/dL. Group II: formed of 30 healthy children (control Group) Results: In the current study we found that there was a significant decrease in weight and BMI among cases group p-value <0.001. In the current study, we found that there was a significant decrease in all CBC parameters among cases versus control. In the current study we found that there were significant differences between the two groups regarding nutritional status as in cases there was a higher percentage of low iron sources in the diet, there was a significant decrease in serum iron, ferritin, and TIBC in cases versus control. In the current study, we found that there was a significant increase in the number of positive samples for H pylori antigen in stool among cases versus control 63.3% versus 23.3% p-value 0.002. Conclusion: The results of this study demonstrate a significant association between children with iron deficiency anemia and positive H. pylori infection in school-age children. Moreover, H. pylori infection may be one of the significant causes of iron deficiency anemia.

S2174 Treatment of Hyperplastic Gastric Polyps With Band Ligation for Transfusion Dependent Iron Deficiency Anemia

INTRODUCTION: Hyperplastic gastric polyps (HGP) are a common incidental finding on Esophagogastroduodenoscopy (EGD). However, they are an infrequent cause of iron deficiency anemia (IDA) requiring transfusion. Prior case studies have shown the potential of band ligation as a treatment option for bleeding HGP. This case outlines the successful use of band ligation in this rare case of bleeding HGP causing transfusion dependent iron deficiency anemia. CASE DESCRIPTION/METHODS: A 78-year-old female, with a history of HGP status post polypectomy two years prior to admission, coronary artery disease with recentcardiac stent placement and initiation of dual anti-platelet therapy (DAPT), presented with melena and fatigue. She presented hemodynamically stable and her labs were remarkable for acute on chronic IDA requiring recurrent transfusions. EGD was notable for multiple 4–7 mm friable sessile polyps with small ulcerations found in the gastric body. No therapeutic intervention was performed as decision to conservatively support the patient was made in the setting of the bleeding risks on DAPT. She was discharged with a stable hemoglobin and future endoscopic treatment once DAPT was able to be held. One week later she returned with similar complaints and was found to have recurrent acute on chronic IDA. Repeat EGD was significant for multiple sessile polyps with stigmata of recent bleeding and ulcerations. Due to her refractory anemia requiring transfusions, it was decided to treat with targeted band ligation of 5 HGP with the most bleeding potential. She again presented 2 days after discharge with similar complaints and recurrent anemia. Push enteroscopy showed blood from an indeterminate source as well as the 5 previously banded polyps without signs of bleeding. Her symptoms resolved and her hemoglobin continued to improve. Four months later her hemoglobin remained stable and she continued to be asymptomatic. DISCUSSION: This case demonstrates the potential of band ligation as a safe and effective treatment option for recurrent bleeding HGP. Compared with a 7.2% bleeding complication rate post-polypectomy a previous trial showed that band ligation had a 0% bleeding complication rate.1,2 We also see the effects of band ligation leading to ulceration of the site and eventual scarring. Consistently, Lo CC et al. showed that all polyps dropped off following ligation. Band ligation is a promising low-risk treatment option for recurrent bleeding HGP and requires further investigation.Figure 1.: Multiple, friable hyperplastic gastric polyps in the gastric body.Figure 2.: Band ligation of hyperplastic gastric polyps.Figure 3.: Area of scarring status post band ligation of hyperplastic polyps.

A cross-sectional observational study assessing the clinical profile of patients with iron deficiency anaemia

Background: Our objective in this research was to study the clinical profile of patients having iron deficiency anaemia.Methods: This was an observational cross sectional study conducted in Medicine out-patient and in-patient departments of Baroda Medical College and SSG Hospital, Vadodara from February, 2018 to November, 2018 and included all patients (N=50) above eighteen years of age who were diagnosed on admission with microcytic hypochromic or normocytic normochromic anaemia. Following detailed history, general examination and basic haematological investigations like complete blood count, haemoglobin, mean corpuscular volume, etc., statistical analysis of the data was performed.Results: In the present study, it was found that maximum number of patients belonged to a younger age group (mean=36.82 years) with a majority being females (74%). Most common presenting complaint was weakness seen in 96% cases while the commonest clinical finding was pallor present in 100% cases followed by koilonychia in 32%. The most common cause of iron deficiency anaemia was nutritional seen in 60% patients.Conclusions: Generalised weakness, breathlessness, and pedal edema were the commonest presenting complaints in our study while pallor, koilonychia, and pedal edema were the most common clinical findings. Maximum number of patients had IDA due to a nutritional cause. Chronic gastrointestinal bleeding, inflammatory bowel disease, and menorrhagia are other causes of IDA. Amongst addicted, alcohol addiction seen in most cases.

Role of upper gastrointestinal endoscopy in children with iron deficiency anemia in western Rajasthan

Upper gastrointestinal (UGI) endoscopy reveals abnormal pathological findings in 55% patients of iron deficiency anemia therefore gastrointestinal pathology should be ruled out iron deficiency anemia not responding to the treatment.To determine the role of upper gastrointestinal endoscopy and find out the pathological changes which occur in children with iron deficiency anemia (IDA) This cross-sectional study included 95 pediatric patients with iron deficiency anemia in the age group between 3 to 17 years who underwent routine upper gastrointestinal endoscopy. All potential bleeding lesions were identified and biopsy samples were taken from 2 part of duodenum for histopathological examinations. The mean age of cases was 7.3±3.3 years. Endoscopy revealed abnormal finding in 63.1% patients. The gastrointestinal pathologies identified were celiac disease in 22 patients, nonspecific duodenitis in 11 patients, H.Pylori duodenitis in 8 patients, erosive duodenitis in 7 patients and giardiasis in 3 patients. Upper gastrointestinal endoscopy has a definitive role in identifying the underlying cause of iron deficiency anemia in patients not responding to conventional therapy.