Introduction Iron Deficiency Anaemia Research Articles

Increasing rates of screening and treatment of iron deficiency in ambulatory patients with heart failure with reduced ejection fraction: a quality improvement cohort study

IntroductionIron deficiency anaemia (IDA) is common in patients with heart failure (HF) and is associated with advanced HF and increased mortality. Intravenous iron supplementation increases exercise tolerance, improves quality of...

Predicting response to iron supplementation in patients with active inflammatory bowel disease (PRIme): a randomised trial protocol

IntroductionIron deficiency anaemia (IDA) is the most common systemic manifestation of inflammatory bowel disease (IBD) that has detrimental effects on quality of life (QoL) and disease outcomes. Iron deficiency (ID),...

Ferric derisomaltose and Outcomes in the Recovery of Gynecologic oncology: ERAS (Enhanced Recovery After Surgery) (FORGE) – a protocol for a pilot randomised double-blinded parallel-group placebo-controlled study of the feasibility and efficacy of intravenous ferric derisomaltose to correct preoperative iron-deficiency anaemia in patients undergoing gynaecological oncology surgery

IntroductionIron-deficiency anaemia is common in gynaecological oncology patients. Blood transfusions are immunosuppressive and carry immediate and long-term risks. Oral iron replacement remains the standard of care but requires prolonged treatment...

Dietary iron intakes and odds of iron deficiency anaemia among pregnant women in Ifako-Ijaiye, Lagos, Nigeria: a cross-sectional study.

Introductioniron deficiency anaemia (IDA) in pregnancy is a prominent risk factor for maternal mortality and poor pregnancy outcomes in low- and middle-income countries, but studies on the significance of dietary iron intake (DII) in IDA in this population are limited. This study assessed the association of DII with odds of IDA among pregnant women attending primary health centres in Ifako-Ijaiye, Lagos, Nigeria.Methodssociodemographic information and dietary intakes were assessed among 432 singleton pregnant women (without pre-existing medical complications) using a pre-tested questionnaire and 24 hr-dietary recall, respectively. Dietary iron intake (DII) was derived from the 24 hr-dietary recall using the West African food composition table. Haemoglobin (Hb) levels in blood samples were measured using the haemoglobin-cyanide technique, and IDA was defined using the World Health Organization criteria. Multivariable-adjusted odds ratios (OR) of IDA and 95% confidence intervals (CI) by energy-adjusted tertiles of DII were estimated using logistic regression with a two-sided P<0.05.Resultsmean age of respondents was 28.5 ± 4.6 years, and the average gestational age was 31.3 ± 4.1 weeks. Mean DII was 20.3 ± 3.3 mg/day, and Hb concentration was 97.9 ± 12.9 g/L. Furthermore, 83.8% had IDA and multivariable-adjusted OR and 95% CI for odds of IDA across tertiles of energy-adjusted DII were 1.00, 0.32 (0.05, 1.77), 0.07 (0.01, 0.36) P for trend < 0.0001 adjusting for age, primigravidae status and monthly income.Conclusionhigher DII was inversely associated with the odds of IDA among pregnant women. Behavioural change communication promoting the consumption of iron-rich foods might be a viable dietary strategy to alleviate the high burden of IDA among women in this population.

The Prevalence of Lymphocytopenia Among Arab Population with Iron Deficiency Anemia an Experience from Qatar

Introduction Iron deficiency anaemia (IDA) is one of the most common health problems worldwide, its prevalence is up to 1 in 5 of the general population. The diagnosis of absolute iron deficiency is easy unless the condition is masked by inflammatory conditions. All cases of iron deficiency should be assessed for treatment and underlying cause.In developing countries, iron deficiency anemia is nutritional, resulting from reduced intake of bioavailable iron , and often associated with infections causing hemorrhages, such as hookworm infestation . In Western societies, other than in individuals at risk, iron depletion results from chronic bleeding and/or reduced iron absorption, disorders that may be more relevant than anemia itself.The association between IDA and lymphocytopenia is poorly addressed in the literature. Objective: To assess the prevalence of lymphocytopenia in a large cohort with IDA and to study the effect of iron replacement on lymphocytes count. Materials and Methods We retrospectively reviewed the electronic medical records of patients attended haematology clinic with the diagnosis of IDA over 2 years in Hamad Medical Corporation, Qatar. Patients with other forms of anemia were excluded as those with chronic or systemic diseases. Complete blood count and iron parameters were collected and analysed. Lymphocytopenia was defined as lymphocyte count less than 1000/microlitre. Statistical analysis was done using mean and SD and paired t test to compare variables after versus before treatment. Results The mean age of our IDA patients was 37.95 years with a mean BMI = 31.82. Out of 1567 case of IDA, 20 had lymphocytopenia, (1.276%). The mean lymphocytes count mean increased from 0.73 +/- 0.15 x 10^9 before iron replacement, to 1.79 +/- 0.74 x 10^9 after iron treatment (p &amp;lt; 0.05) (iron dose of 1000 mg of IV iron saccharate or ferric carboxymaltose) . Four out of the 20 patients with lymphopenia had mild infections (2 upper respiratory tract infections, 1 urinary tract infection and one gastroenteritis) with no serious complications. These findings suggested that the lymphopenia associated with IDA is correctable and does not increase infection risk in these patients. Discussion Our study showed a possible negative impact of IDA on lymphocytes count in a small number of patients that was corrected with the correction of anemia with iron therapy. Animal studies showed that iron deficiency may lead to impaired T lymphoid differentiation and may negatively affect all cell lineage in haematopoiesis not only on erythroid line. A case control study by Das et al. found significantly lower levels of CD4+ T-cell counts and CD4:CD8 ratios in iron deficient children, however there was no significant effect on immunoglobulin levels. Conclusions: Lymphopenia may occur in a small percentage of patients with IDA. Significant increase in the lymphocyte count occur with iron therapy and correction of the anemia. Lymphopenia was not associated with serious infections. Disclosures No relevant conflicts of interest to declare.

4 Iron deficiency in heart failure patients in england: insights from analysis of hospital episode statistics

IntroductionIron deficiency (ID) has been shown to be present in about 50% of patients with heart failure (HF). Associated with a poor quality of life, impaired effort tolerance, and increased...

OC-021 Should the Renal Tract be Routinely Investigated in Iron Deficiency Anaemia?

Introduction Iron deficiency anaemia (IDA) accounts for 4–13% of referrals to gastroenterology. The British Society of Gastronterology IDA guidelines recommend the investigation of the gastrointestinal (GI) tract, but not the renal tract. A single consultant led one stop IDA clinic was set up. As part of the evaluation of IDA, urine microscopy and an ultrasound or CT abdomen/pelvis (if used in lower GI tract examination) were performed to investigate for renal tract malignancies, alongside GI tract investigations. We aimed to demonstrate the yield of renal and GI tract malignancies in patients with IDA. Methods Patients with IDA or isolated hypoferritinaemia attending the clinic from 2013–2015 who underwent urine microscopy and an ultrasound or CT abdomen/pelvis alongside bidirectional GI investigations (Upper GI: gastroscopy/barium swallow/CT; lower GI: colonoscopy/barium enema/CT) were analysed. We described the yield of haematuria from urine microscopy and the yield of malignancy from renal and GI tract investigations. Results A total of 196 patients had renal tract investigations alongside bidirectional GI investigations (152 urinalysis/ultrasound, 44 urinalysis/CT). 6.1% (12/196) patients had microscopic haematuria. Four renal tract cancers were found: 2 from the haematuria group and 2 from the normal urine microscopy group. In the haematuria group, 2 bladder cancers were identified by CT and cystoscopy respectively. The latter patient was asymptomatic apart from gastroesophageal reflux and had no weight loss. He had a normal gastroscopy, colonoscopy and ultrasound abdomen. A cystoscopy was performed due to the persistent haematuria, which revealed a bladder cancer. In the normal urinalysis group, CT identified 1 prostate cancer and 1 renal cell carcinoma (RCC) where both patients presented with weight loss. The yield of renal tract malignancies in this cohort was 2.0% (4/196). The yield of GI malignancy was 3.1% (6/196) from bidirectional GI investigations in the same cohort of patients. All GI malignancies identified were colorectal cancers. Conclusion The ratio of renal: GI tract malignancies was 2:3 in this cohort. Urine microscopy identified 50% of renal tract cancers. Following the standard practice of bidirectional GI investigations for IDA, the 1 case of asymptomatic bladder cancer would have been missed had urine microscopy not been performed. Routine urine microscopy is easy and cheap to perform, and should be tested in all patients with IDA, and those with haematuria should have their renal tracts investigated. Routine renal tract ultrasound in the asymptomatic IDA patient is not indicated. Disclosure of Interest None Declared

PTU-026 The Yield of Bidirectional Investigations in Iron Deficiency Anaemia – Are Gastroscopies Redundant?: Abstract PTU-026 Table 1

Introduction Iron deficiency anaemia (IDA) is common, affecting 2–5% of people in the developed world. The BSG guidelines recommend bidirectional (upper and lower gastrointestinal [GI] tracts) investigations for patients with IDA in men, and in women who are postmenopausal, age > 50 or with a family history of colorectal cancer (CRC). We aimed to evaluate the yield of bidirectional investigations for GI malignant and non malignant causes. Methods We prospectively collected data on patients attending a single consultant led IDA clinic from 2013–2015. IDA was defined as anaemia with microcytosis, low ferritin, raised zinc protoporphyrin or a compatible iron profile. Gastroscopy and colonoscopy were requested unless frailty, comorbidity, or patient choice dictated otherwise. Alternatives included barium studies, CT pneumocolon or CT abdomen. Coeliac and intrinsic factor (IF) antibodies, urine microscopy and renal tract ultrasound (unless patient had a CT) were also requested. Polyps or ulcers Results A total of 282 IDA and 11 patients with isolated hypoferritinaemia attended the clinic. 21 patients were excluded as they declined investigations, leaving 272 for analysis. 264 (97.1%) patients had UGI tests (240 gastroscopy/20 Barium swallow/4 CT) and 266 (97.8%) had LGI tests (198 colonoscopy/11 barium enema/57 CT). There were 170 symptomatic and 91 asymptomatic IDA patients, and 7 symptomatic and 4 asymptomatic hypoferritinaemic patients. CRC was found in 17 (6.4%) patients, with 10 and 7 in the symptomatic and asymptomatic IDA groups respectively. No malignancies were identified by any gastroscopies. An identifiable non-malignant cause of IDA was found in 8 (3%) gastroscopies. CT identified thickening of the gastric wall in an elderly patient who declined further investigations. In the isolated hypoferritinaemia group, there was no positive yield apart from 1 bleeding haemorrhoids. 1.5% (4/262) patients had pernicious anaemia and 0.7% (2/273) had coeliac disease. Conclusion The yield of UGI and LGI cancer was 0.38% (1/264) and 6.4% (17/266). There was no yield for malignancy from all 240 gastroscopies undertaken. This suggests that gastroscopies provide very limited diagnostic value as a first line investigation in patients with IDA without UGI symptoms or suspected coeliac disease. Disclosure of Interest None Declared

PTH-149 A One Stop Iron Deficiency Anaemia Clinic: A Review of Its Efficacy

Introduction Iron deficiency anaemia (IDA) accounts for 4–13% of referrals to gastroenterology. A single consultant led one stop IDA clinic was set up to streamline all required tests (upper and lower gastrointestinal investigations, coeliac serology, intrinsic factor antibodies, immunoglobulins, urinalysis and ultrasound, or CT if appropriate) at the first clinic in order to reach a diagnosis quicker and reduce unnecessary follow ups. We aimed to evaluate the discharge rate after the first clinic visit compared to patients with IDA attending general gastroenterology clinics, and assess the patients’ compliance of haemoglobin (Hb) monitoring by general practitioners (GP) and response to iron post discharge to primary care. Methods We prospectively reviewed all cases referred with iron deficiency (IDA and isolated hypoferritanaemia) attending the clinic from 2013–14. The discharge rate after the first visit was analysed. We assessed the discharged patients’ response to iron at 3 or 6 months, defined by normalisation of Hb, excluding those with cancer. We reviewed their compliance with Hb monitoring at 3, 6, 9 and 12 months as advised by the consultant in clinic and also via letters to the GPs and patients, and compared it to that of patients who were followed up in clinic. Results A total of 214 iron deficient patients attended the clinic. The discharge rate was 90.2% (193/214) versus 26% for IDA patients attending general gastroenterology clinics (80% consultant led) in our previously published data in 2014. We excluded 24 patients with cancer, and 19 who did not have their Hb checked at 3 or 6 months, leaving 150 discharged patients for analysis. 51.3% (77/150) responded to iron therapy at 3 or 6 months. Of those, 68.8% (33/48) had a sustained response at 12 months after excluding 29 patients who did not have their Hb checked at 12 months. The compliance rate for Hb monitoring by the GP at 3, 6, 9 and 12 months in the discharged group was 24.9% (42/169), versus 9.5% (2/21) in the follow up group. Conclusion This one stop IDA clinic had a significantly higher discharge rate compared to general gastroenterology clinics for IDA patients. Half of the discharged patients had an initial response to iron, where two thirds of them had a sustained response at 12 months. It is unclear whether this was due to poor adherence to iron therapy or missed pathologies, however all patients underwent a comprehensive range of investigations. The compliance with Hb monitoring was low in both the discharge and follow up groups, suggesting that compliance was not necessarily related to whether the patient was followed up or discharged. Further emphasis is needed to relay the importance of Hb monitoring to both patients and GPs, in order to identify those who may require further investigations. Disclosure of Interest None Declared

PTU-014 Relationship between Ferritin/MCV and GI Pathology in Patients Referred from Primary Care with Iron Deficiency Anaemia: Abstract PTU-014 Table 1

Introduction Iron deficiency anaemia (IDA) is common with BSG guidance suggesting Gastrointestinal (GI) blood loss from colonic or gastric cancer, and malabsorption in coeliac disease are the most important causes. 1 Serum ferritin, microcytosis and hypochromia are the most sensitive markers for iron deficiency. 2 Our objective was to investigate the correlation between MCV/ferritin and GI pathology in patients with IDA by comparing GI pathology in patients with low ferritin versus normal ferritin; and in patients with microcytosis versus normocytosis. Methods Retrospective cohort study for consecutive patients who had undergone bi-directional endoscopy and/or GI imaging to investigate unexplained anaemia were included. Data was retrieved including Hb, MCV, folate, B12, co-morbidities and findings at endoscopy, histology and imaging were recorded. Patients with normal haemoglobin as per our laboratory’s cut off were excluded. Included patients were stratified according to serum ferritin and MCV into 2 groups (low/normal) for each marker. We used the cut-off concentration as per our local laboratory (10 µg/l for ferritin and 78 FL for MCV). The outcome assessed was any GI pathology found that may explain the IDA. Data was analysed including and excluding the diagnosis of gastritis/oesophagitis as possible GI causes of anaemia. Results 265 included patients (mean age: 68; range: 16–91 years old; 124 males and 141 females) had undergone GI investigations for IDA. Of these, 84 patients had low ferritin (31.6%) whereas 181 patients had normal ferritin. GI pathology excluding gastritis/oesophagitis occurred in 40 (47.6%) and 68 (37.5%) patients in low and normal ferritin group respectively. P = 0.12. Based on MCV, 96 patients had low MCV (36.2%) whereas 169 patients had normal MCV. GI pathology occurred in 38 patients in low MCV group (39.5%) and in 70 patients with normal MCV (41.4%), P = 0.76. No differences were noted upon including gastritis/oesophagitis. Conclusion There was no clinical or statistical difference in GI pathology in patients presenting with anaemia with or without evidence of iron deficiency. Although a significant number of patients had a GI workup despite no evidence of iron deficiency, the lesion pickup was similar in both groups. Therefore, our study demonstrates the MCV/ferritin might be sensitive markers for IDA but they don’t correlate with GI pathology. References 1 Gut 2011; 60 :1309e–1316. doi:10.1136/gut.2010.228874 2 Prevalence of hypochromia vs microcytosis in iron deficiency. Clin Lab Haematol 2000; 22 :79e80. Disclosure of Interest None Declared

PTH-066 Clinical Trial: Effects of Oral Ferrous Sulphate on Haemoglobin, Hepcidin, Disease Activity, Mood and Quality of Life in Adolescents and Adults with Iron Deficiency Anaemia Due to IBD

Introduction Iron deficiency anaemia (IDA) is common in inflammatory bowel disease (IBD), can be hard to treat and has a negative impact on quality of life (QOL). Because of previous concerns about the efficacy and safety of oral iron, particularly in young people with IBD, we undertook a trial to assess whether ferrous sulphate is as effective and well-tolerated in adolescents as in adults with IBD. Methods Prospective phase IV, open-label, parallel group, 6 week non-inferiority clinical trial to compare the effects of oral ferrous sulphate 200 mg twice daily on Hb, iron status, serum hepcidin, symptoms, disease activity (Harvey-Bradshaw Index, Simple Colitis Clinical Activity Index, C-reactive protein (CRP), faecal calprotectin (FCP), QOL, mood and fatigue psychometric scores in 43 adolescent (age 13–18 years) and 45 adult (>18 years) IBD patients with IDA who were either oral iron-naive or previously iron-tolerant. Results On intention-to treat analysis, ferrous sulphate produced similar small but statistically significant rises in serum Hb in the adolescent (before treatment 10.3 g/dl [0.2] (mean [SEM]); after 11.7 [0.2]: p Conclusion Oral ferrous sulphate is no less effective or well-tolerated in adolescents than in adults with IBD, and does not increase disease activity. Baseline serum hepcidin level is inversely related to the increase in Hb produced by oral iron in patients with IBD: its measurement could indicate which patients would do better with intravenous than oral iron. Change in Hb had no effect on QoL, mood or fatigue scores. Disclosure of Interest None Declared

PTH-051 Influence of Iron Supplementation on The Natural History of Colitis

Introduction Iron deficiency anaemia is common in IBD. Iron supplementation may induce or exacerbate colitis in rats (APT 2001;15:1989–99).Dysbiosis of the microbiota is common in IBD and iron contributes to this as it is a growth factor for pathogenic bacteria.We investigated the effect of dietary iron supplementation and/or reduction on the severity of chronic colitis in a murine model using clinical, histological and biochemical parameters. Methods Studies were performed on 6 groups of 8 wild type (WT) C57BL/6 mice.Chronic colitis was induced with 1.25% Dextran Sodium Sulphate (DSS) for 5 days,followed by16 further days on water [for 3 consecutive cycles]. DSS-treated mice were fed one of three diets:low iron [LI] (100 ppm), normal iron [NI] (200 ppm) and high iron[HI] (400 ppm) supplemented chow. Also, 3 non-DSS-treated groups were studied and fed similarly. Half of the mice in each control group were treated with 1 cycle of acute 2% DSS for 5 days at day 53, followed by 5 further days on water. All mice were sacrificed at day 63. Daily weights and clinical features were recorded. Histological colitis was scored using the Bauer score(Gut 2010; 59:1192–99).Faecal calprotectin was measured by ELISA and faecal iron by immunoassay at various time points [day (d) 1, 21, 42 & 63]. Statistical analyses used the Kruskal–Wallis test with post-hoc analysis. Results Oral DSS administration induced colitis in all treated mice. While chronic DSS colitis was not associated with weight loss, there was severe weight loss in acute DSS mice which was greatest in the low iron diet group (p = 0.001 LI vs. HI; p = 0.01 for LI vs. NI). Histologically, the colitis features were more prominent in acute DSS-treated mice ingesting low and high iron diets, with median colitis scores 6 & 5.5 respectively.Cyclic administration of DSS in drinking water resulted in a significant rise in faecal calprotectin, from baseline to d63 in LI (p = 0.05) and for HI (p = 0.01), but this was not significant in the NI group. In acute DSS, the rise was greater in LI and HI (p = 0.001) and less in NI (p = 0.01).Total faecal iron was increased in a dose-dependent manner within 9 weeks in all non-DSS groups. Nevertheless, in chronic DSS groups, p = 0.001 at d1 vs. d63 for all groups [382% change for LI, 331% for NI and 355% for HI].However, in acute DSS p = 0.05 for LI, p = 0.001 NI & HI (d1 vs. d10). Conclusion Changes in nutritional luminal iron exacerbate colitis.Oral administration of DSS causes a reproducible acute colitis, followed by a slow recovery phase with a concomitant chronic inflammation. Chronic colitis was worse in mice fed low or high iron diets, as shown by elevated calprotectin. Faecal iron rose equally in all 3 groups: with iron increases likely arising from diet and bleeding during colitis. Dysbiosis may be a consequence of this change in luminal iron. Disclosure of Interest None Declared

Iron Age or New Age: Ironing out the Diagnosis of Anaemia of Inflammation from Iron Deficiency Anaemia

▪IntroductionIron deficiency anaemia (IDA) and anaemia of chronic inflammation (AI) are the most prevalent causes of iron related anaemia in subjects with gastrointestinal disorders contributing significantly to morbidity and mortality. Diagnosis of IDA and AI is not always straight forward and currently a combination of several serum parameters (ferritin, transferrin, transferrin saturation, iron and C-reactive protein) is required. Subjects with a mixed aetiology can be difficult to interpret using traditional serum parameters, particularly in the presence of an inflammatory process. Hepcidin (a 25 amino-acid peptide hormone) in conjunction with reticulocyte haemoglobin equivalent (RetHe) has the potential to differentiate IDA from AI and in cases of mixed aetiology replacing the traditional laboratory parameters (serum iron, CRP, transferrin saturation and ferritin).AimThe aim of the study was to evaluate the performance of a commercially available ELISA assay and investigate whether hepcidin and RetHe can differentiate AI from mixed aetiology.MethodThe study investigated 77 patients with gastrointestinal disorders associated with anaemia in a secondary care setting using a traditional pathway of 6 tests (figure 1): Complete Blood Count (CBC), Reticulocytes, serum ferritin, CRP, transferrin, serum Iron. Hepcidin concentration was measured using a commercially available ELISA method (DRG Diagnostic GmbH, Marburg, Germany), CBC and RetHe using a Sysmex XE-2100 CBC analyser, iron parameters and CRP using Beckman Coulter platforms.ResultsHepcidin correlated well with ferritin R2 = 0.79, p<0.0001. The results were compared to traditional parameters with Receiver Operator Curves (ROC) used to determine diagnostic cut off concentrations (table 1).Table 1Sensitivity and specificity of serum ferritin and serum hepcidin used to determine diagnostic cut off values.Selected cut off valuesIDAAISerum ferritin 30.0µg/LSensitivity 83% Specificity 64%Sensitivity 55% Specificity 75%Serum hepcidin 8ng/mLSensitivity 73% Specificity 72%Sensitivity 70% Specificity 67%Serum hepcidin 40ng/mLSensitivity 98% Specificity 32%Sensitivity 25% Specificity 91%Ferritin was unable to distinguish IDA from AI in mixed aetiology situations. This gives rise to a new proposed 2 step pathway (figure 2) using 3 tests: CBC, RetHe and hepcidin differentiating IDA from AI in mixed aetiology cases indicating the cause of the anaemia. The RetHe value can then be used to predict the response to oral iron.ConclusionSerum hepcidin may not yet replace serum ferritin as the preferred iron status marker, but in conjunction with RetHe it may distinguish mixed aetiology subjects. This offers the potential development of a clearer clinical pathway for investigation of difficult subjects, including reduction in the number of tests required during anaemia investigations and shorter diagnosis times. The advantage of hepcidin together with RetHe over traditional iron parameters is both as a real time marker of iron status and an indication of likelihood of response to iron therapy. The patient would benefit from a shorter recovery time, unnecessary testing, reduction in ineffective treatment and overall reduction in costs. [Display omitted] [Display omitted] DisclosuresPatmore:Janssen: Honoraria; Gilead: Honoraria.

OC-057 Anaemia and iron deficiency in adults; how to manage it for nurses. a new guide from the royal college of nursing

Introduction Iron deficiency anaemia (IDA) is the most common cause of anaemia in primary care and causes >57,000 emergency admissions to hospital/yr at a cost to the NHS of £55.48 m. Effective identification and management is often overlooked. Dealing with IDA prevents complications and blood transfusion use with a cost saving of £8.43 m per year. These guidelines have been developed by expert nurses from relevant specialties. They are aimed at all nurses, health care assistants, midwives and health visitors from all specialties and backgrounds. Method The document gives guidance on; identifying IDA and escalating management understanding how IDA occurs, give dietary advice and using oral iron supplements, the use of intravenous iron with practical tips for its delivery.good patient information links. It gives specialist guidance to nurses working in renal disease, gastroenterology, obstetrics and gynaecology and patient blood management. Results The main guidance contains; Definition of IDA, iron metabolism and pathophysiology, storage or iron, causes of functional and actual iron deficiency, measuring iron status, common symptoms of anaemia, history taking and examination, dietary iron, oral iron supplements, practical advice for administrating intravenous iron, use of blood transfusion and preoperative optimisation of patients. The GI appendix discusses IDA in coeliac disease and inflammatory bowel disease, and gives case study examples to show the impact of effective nursing intervention on patiient outcomes. Conclusion These newly published Royal College of Nursing Guidelines provide an invaluable resource about all areas of iron deficiency management for nurses from all backgrounds and specialties. The specialist appendices provide extra information for nurses working within renal disease, obstetrics and gyanecology, patient blood management and gastroenterology. Disclosure of interest None Declared.

PTU-072 The influence of iron supplementation on the severity of a murine model of colitis

Introduction Iron deficiency anaemia is a common complication in inflammatory bowel disease (IBD). There is evidence that iron supplementation induces inflammation both in normal rats and in rodent models of IBD (Carrier J et al , Aliment Pharmacol Ther. 2001 Dec; 15(12): 1989–99.). Changes in the gut microbiota [dysbiosis] are common in IBD patients, but the mechanism is unclear. Iron may be a factor, as it is a growth factor for some bacteria. We have therefore investigated the effect of dietary iron intake upon a murine model of colitis. Method Animal studies were performed on 6 groups of female C57BL/6 mice. Acute colitis was induced with 2% Dextran Sodium Sulphate (DSS) for 5 days in drinking water before go back on a normal water for a another 5 days. Two modifications of diet (normal chow 200 ppm iron) were used: low iron (100 ppm) and high iron (400 ppm). The groups were 1 controls; 2 acute DSS normal diet; 3 acute DSS with low iron diet for 10 days; 4 acute DSS with high iron diet for 10 days; 5 low iron diet for 4 weeks; 6 high iron diet for 4 weeks. Daily weight and clinical features were logged. Histology was performed at day 10 for groups 1–4 and day 28 for the rest. Colitis was scored using the Bauer score (Bauer et al , Gut 2010; 59:9 1192–1199). Faecal Calprotectin measured by ELISA (Biohit Healthcare Ltd.), and faecal iron by immunoassay. One ANOVA and t tests were performed to compare groups or pairs of samples. Results Weight loss: DSS induced colitis in groups 2–4; it was most severe in the low iron group. Mean changes in weight were +4% in control, -5.3% in group 2, -9.2% in group 3, and -1% in group 4. Post-hoc testing showed p values of 0.0005, 0.16 and 0.01 for low iron diet vs groups 1, 2 and 4, respectively. Histology: mean colitis scores were; 0, 1.4, 1.9, 1.4, 0, 0 for groups 1–6, respectively. The score to low iron DSS mice was significantly worse than that in untreated mice and marginally worse than those on normal or high iron diets. Calprotectin: calprotectin concentrations were greatest in DSS mice on the low iron diet. Faecal iron: this was increased in a dose-dependent manner within 4 weeks in the groups of mice that did not receive DSS. In DSS treated mice, the low iron diet mice resulted in the highest faecal iron results p = 0.010, 0.0024, and 0.0019 for groups 1, 2 and 4 respectively. Conclusion Clinical observation and histological scoring showed that a low iron diet exacerbated DSS colitis. Mice consuming 50% of the normal amount of iron lost more weight and developed more severe colitis than other mice given DSS. The high iron diet had no measureable effect on the severity of DSS colitis. We will now investigate the effects of iron on the intestinal microbiota in the 6 groups. Disclosure of interest None Declared.

PTH-131 First Year Results from a Virtual Iron Deficiency Anaemia Service at a District General Hospital

IntroductionIron deficiency anaemia (IDA) has a prevalence of up to 5% in adult men and post-menopausal women, and is a common cause of referral to gastroenterologists. Important and common causes...

PWE-154 Iron Deficiency Anaemia as an Indicator of Malignancy - The Idiom Study

IntroductionIron deficiency anaemia (IDA) is common. It is of particular importance because about 10% of subjects with IDA over the age of 50 will have an underlying gastro-intestinal (GI) malignancy,...

PWE-190 Outcome of Investigations for Iron Deficiency Anaemia in Men under 50 Years

IntroductionIron-deficiency anaemia (IDA) occurs in 2–5% of men and postmenopausal women in the developed world. IDA is commonly due to blood loss from lesions in the gastrointestinal (GI) tract and...

PTH-113 Clinical Response to Induction Anti-Tnf Therapy has no Effect on Haemoglobin Levels in Patients with IBD

IntroductionIron deficiency anaemia (IDA), as a consequence of intestinal bleeding and inflammation, is arguably the most common complication of inflammatory bowel disease (IBD). In controlled trials, oral iron is reportedly...

PWE-050 An Evaluation of Patients Referred to Gastroenterology Anaemia Clinic

IntroductionIron-deficiency anaemia in adults is a common cause of referral to gastroenterologists (4–13% of referrals). NICE guidelines, UK provides clear recommendations regarding upper and lower gastrointestinal investigations for such patients...