Mean Corpuscular Volume Levels Research Articles

Serum ubiquitin levels in patients with alcoholic liver disease.

Serum concentrations of free ubiquitin and multiubiquitin chain as determined by immunoassays were compared between 10 healthy subjects, and 11 patients with alcoholic hepatic fibrosis, 10 with alcoholic cirrhosis, and 6 with viral liver cirrhosis. All measurements of multiubiquitin chains were expressed in terms of a standard multiubiquitin chain reference preparation 1. Serum concentrations (mean +/- SD) of free ubiquitin and multiubiquitin chains were significantly higher in patients with alcoholic cirrhosis (63.5 +/- 33.7 ng/ml and 7.5 +/- 4.6 ng/ml) than in the normal subjects (29.6 +/- 6.6 ng/ml, p < 0.05 and 4.1 +/- 1.7 ng/ml, p < 0.05), and those with alcoholic hepatic fibrosis (34.8 +/- 16.3 ng/ml, p < 0.05 and 3.0 +/- 0.7 ng/ml, p < 0.05) and viral liver cirrhosis (28.8 +/- 7.5 ng/ml, p < 0.05 and 4.2 +/- 1.3 ng/ml, p < 0.05). Serum levels of both forms of ubiquitin in six patients with alcoholic cirrhosis showed a tendency to decline after 3 months of abstinence. In a total of 14 patients with alcoholic liver damage, 11 with brain atrophy had significantly higher serum levels of both ubiquitin forms than did three patients without brain atrophy (p < 0.05). No correlation was seen between serum concentrations of either form of ubiquitin and liver function test results in the patients with alcoholic liver damage. However, serum levels of both forms of ubiquitin levels correlated significantly with cumulative alcohol intake (p < 0.05). A significant correlation (p < 0.05) also was observed between serum levels of multiubiquitin chains and mean corpuscular volume, a marker of alcohol consumption. These results suggest that the serum concentrations of ubiquitin, especially multiubiquitin chain is a good marker for the diagnosis of alcoholic cirrhosis.

Relation of serum ascorbic acid to serum vitamin B12, serum ferritin, and kidney stones in US adults.

Concern has been raised that high levels of ascorbic acid consumption may lead to potential adverse effects, such as vitamin B12 deficiency, iron overload, and kidney stones. To examine the relation of serum ascorbic acid level, which reflects intake, to serum vitamin B12 level, serum ferritin level, and kidney stones. We analyzed data collected on a random sample of the US population enrolled in the Second National Health and Nutrition Examination Survey, 1976-1980. We analyzed data using linear and logistic regression models. Serum ascorbic acid, serum vitamin B12, hemoglobin, red blood cell mean corpuscular volume (MCV), and serum ferritin levels were measured using standardized protocols. History of kidney stones was determined by self-report. After multivariate adjustment, serum ascorbic acid level was associated with higher serum vitamin B12 levels among women in regression models that assumed a linear relationship; each 57-pmol/L (1.0-mg/dL) increase in serum ascorbic acid level (range, 6-153 micromol/L [0.1 to 2.7 mg/dL]) was independently associated with a serum vitamin B12 level increase of 60 pmol/L (81 pg/ mL) (P<.001). Among men, serum ascorbic acid level was marginally associated with higher serum vitamin B12 levels: each 57-micromol/L (1.0-mg/dL) increase in serum ascorbic acid level was associated with a serum vitamin B12 level increase of 27 pmol/L (36 pg/mL) (P = .10). In addition, serum ascorbic acid level was not associated with correlates of vitamin B12 deficiency, such as higher MCV levels, macrocytosis (MCV >100), or lower hemoglobin concentrations. Serum ascorbic acid level was not independently associated with serum ferritin levels. However, among women only, serum ascorbic acid levels were associated in a nonlinear fashion with prevalence of elevated serum ferritin levels (P = .02). We found no association between serum ascorbic acid level and prevalence of kidney stones in women or men (both P>.05). Serum ascorbic acid levels were not associated with decreased serum vitamin B12 levels (or indicators of vitamin B12 deficiency), prevalence of kidney stones, serum ferritin levels, or-among men-prevalence of elevated serum ferritin levels. Serum ascorbic acid levels were associated with prevalence of elevated serum ferritin levels among women. Although the clinical relevance of these findings is uncertain, it seems prudent to suggest that women with a genetic susceptibility to iron overload should consider moderating their intake of ascorbic acid.

Joint influence of alcohol, tobacco, and coffee on biological markers of heavy drinking in alcoholics

Background: Recent reports suggest that gamma-glutamyl transferase (GGT) decreases with coffee intake. The aim of this study was to examine the joint influence of alcohol, tobacco, cotinine, coffee, and caffeine on biological markers of heavy drinking in an alcoholic population. Methods: Subjects were 160 alcohol-dependent inpatients. Biological assessments, performed at admission, were plasma levels of GGT, apolipoprotein AI, aspartate aminotransferase, and mean corpuscular volume (MCV), and urine cotinine and caffeine indexes. Years of alcohol abuse and of smoking, alcohol and coffee intake, and smoking rate were estimated in a semistructured interview, and Fagerström Tolerance Questionnaire was completed by inpatients. Results: Coffee intake, but not caffeine, correlated negatively with biological markers of heavy drinking, after controlling for alcohol and tobacco intake. Years of smoking correlated positively to MCV, after controlling for alcohol and coffee intake. Conclusions: Concerning the effect of coffee, the most likely hypothesis is that noncaffeine coffee fractions have a protective effect on liver cells. Concerning the effect of smoking, one can propose that the increase of MCV with smoking could be a consequence of carbon monoxide inhalation, leading to hypoxemia, or of folate deficiency.

Increased serum copper and decreased serum zinc levels in children with iron deficiency anemia.

In order to evaluate serum copper and zinc status in children with iron deficiency anemia (IDA), 60 children with IDA aged 1-14 yr and 64 healthy children as controls aged 1-14 yr were included the study. Serum copper levels were higher in children with IDA (189 +/- 49 micrograms/dL) than those of controls (163 +/- 37 micrograms/dL) (p = 0.001). Serum zinc levels were lower in the patient group (109 +/- 59 micrograms/dL) than those of control subjects (135 +/- 56 micrograms/dL) (p = 0.017). In addition, there were statistically significant negative correlations between hematological parameters and serum copper levels in the patient group, but not in controls. No correlation between hematological parameters and serum zinc levels were found in both patient and control groups, except positive correlation between mean corpuscular volume (MCV) and serum zinc level in patients. It was concluded that at the time of managing children with IDA, zinc deficiency must be borne in mind and if necessary treatment should be initiated with zinc.

Prevalence of beta-thalassaemia trait in 1124 students from Aegean region of Turkey.

Although the beta (beta) thalassaemia carrier frequency in Turkey was stated to be 2 per cent, the prevalence rate varies widely in different regions and there is limited data confirming the disorder in Aegean region. This prevalence study was planned to determine frequency of beta thalassaemia trait in the Aegean region among 1124 high school students, between 13 and 18 years old, who were selected as target population. Sensitivity of mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) in prediction of beta thalassaemia trait were evaluated. Venous blood samples were obtained for haemoglobin electrophoresis, HbA2 and HbF, serum iron and total iron binding capacity from students in whom the levels of haemoglobin (Hb), haemotocrite (Hct), MCV, or MCH, were low compared to normal values. The prevalence of beta thalassaemia trait in Aegean region was 3 per cent. Sensitivity of MCV and MCH for determining beta thalassaemia trait were 100 and 96 per cent, respectively.

Screening for Excessive Alcohol Drinking

<h3>Background:</h3> Screening medical patients for excessive alcohol drinking is important because minimal intervention by physicians is effective in reducing excessive consumption. Screening tests, such as biologic markers of alcohol consumption, should therefore be investigated to assess their validity to detect alcohol drinking. <h3>Method:</h3> Levels of carbohydrate-deficient transferrin (CDT), γ-glutamyltransferase (GGT), and mean corpuscular volume (MCV) were determined in 1202 consecutive patients (20 to 75 years old) seen at the medical emergency ward (n=552) and the primary care center (n=650) of a city and teaching hospital. Each eligible patient was administered a CAGE questionnaire (an acronym for questions regarding cutting down on drinking,<i>annoyance</i>at others' concern about drinking, feeling<i>guilty</i>about drinking, and using alcohol as an<i>eye-opener</i>in the morning), and for each CAGE-positive patient (score ≥1) as well as for a random sex-matched sample of CAGE-negative patients, standardized data about the recent level of alcohol drinking, morbidities, drug therapy, and smoking were recorded. The operating characteristics of CDT, GGT, and MCV were determined according to alcohol consumption and the CAGE test. Sensitivities, specificities, and receiver operating characteristic curves were computed to compare the tests at different cutoff values. <h3>Results:</h3> Levels of CDT were elevated in 21% of men and 7% of women. According to recent alcohol consumption in men (&gt;60 g/d), the respective sensitivity and specificity of the tests were 0.58 and 0.82 for CDT, 0.69 and 0.65 for GGT, and 0.27 and 0.91 for MCV. Overall, receiver operating characteristic curves demonstrated similar performance of the three tests for screening of excessive alcohol drinking or alcohol abuse. However, in young men (&lt;40 years of age) and in smokers, CDT was superior to GGT or MCV. <h3>Conclusions:</h3> The study suggests that CDT determination may be a useful test for screening programs of excessive alcohol drinking in young male medical patients. (Arch Intern Med. 1995;155:1907-1911)

ALCOHOL CONSUMPTION AND VISUAL CONTRAST SENSITIVITY

Visual contrast sensitivity (VCS) was measured in 30 alcoholic patients and 52 controls. The results showed a significant reduction in VCS for all the spatial frequencies. The mean reduction for all spatial frequencies was 2.49 dB below the level of the control group. Optimal sensitivity corresponded to a lower spatial frequency in patients than controls, i.e. 1 cycle/degree (c/d) versus 2 c/d. Curves for VCS were normal for five patients. Abnormalities in VCS were suggestive of optic nerve dysfunction for 15 patients (50%), which were probable in seven cases (23%) and possible in eight others (27%). For 10 subjects, the abnormalities were indicative of ametropia. Daily alcohol intake and daily tobacco consumption were not significantly different in the patients who displayed VCS abnormalities, reflecting alcohol-tobacco amblyopia, from those who did not. The presence of higher gamma-glutamyl transpeptidase and mean corpuscular volume levels in patients who had VCS abnormalities indicative of alcohol-tobacco amblyopia suggests that alcohol consumption is involved in the development of these abnormalities.

Assessment and monitoring of alcohol-related problems.

Employers are increasingly requesting employees to submit to screening for alcohol-related problems (ARPs). Holistic assessment, leading to problem identification and treatment, can lead to a reduction in the number of accidents occurring in the workplace. This article argues against the practice of assessment based solely on blood levels of liver enzymes and mean corpuscular volume of erythrocytes and introduces a new diagnostic test which, if used with a full and systematic assessment, may lead to more accuracy in diagnostic interpretation.

Trypanosoma congolense: Comparative Effects of a Primary Infection on Bone Marrow Progenitor Cells from N′Dama and Boran Cattle

Using in vitro clonogenic assays, the changes in haemopoietic progenitor cell levels were compared in the bone marrow of three adult trypanotolerant N′Dama cattle and three age-matched trypanosusceptible Boran cattle over 17 weeks (119 days) of a primary Trypanosoma congolense (clone IL 1180) infection. As the infection progressed, a clear tendency of the parasitaemia to decrease was seen in the N′Damas, while it remained high throughout the infection in the Borans. The decline in the colony-forming units-granulocyte macrophage (CFU-GM) between 7 and 42 days postinfection (dpi) corresponded with the decreased numbers of neutrophils and monocytes in the blood observed in both breeds. Thereafter, a further significant drop in the CFU-GM levels was observed in the Borans which may partially explain the continued decrease in the numbers of neutrophils and monocytes in blood. In contrast, a significant peak of CFU-GM above preinfection levels was observed in the N′Damas on 49 dpi, which could partially explain the subsequent recovery of the numbers of neutrophils and monocytes in blood. When compared to the N′Damas, the Borans had a more dramatic drop in the packed cell volume (PCV) from 25 dpi onwards, resulting in significantly lower PCV. From 46-49 dpi onwards, the mean PCV stabilised at significantly lower levels in the Borans than in the N′Damas. The mean corpuscular volume (MCV) levels increased in both breeds, but at a much faster rate in the Borans. The clonegenic assays demonstrated an erythropoietic response, characterised by peaks above preinfection levels of both the early and late erythroid progenitor cells (respectively, burst-forming units-erythroid, BFU-E, and colony-forming units-erythroid, CFU-E), occurring between 35 and 70 dpi in both breeds of cattle. However, despite a more severe anaemia in the Borans, the magnitude of their erythroid response was similar to that of the N′Damas, suggesting that the response of the Borans was insufficient to compensate for the greater degree of anaemia. Moreover, the mean PCV did not improve in the Borans, indicating the ineffectiveness of their erythropoietic response. An increased rate of erythrocyte destruction and/or a defective differentiation and maturation of erythroid precursors have also been shown to be partially responsible for this persistent anaemia. From 98 dpi onwards, despite the persistent low PCV, the MCV decreased to preinfection levels and low CFU-E numbers were observed in the Borans. Over the same period, in the N′Damas the mean PCV progressively increased to reach 25%, which fell within the low normal range for cattle. This may partially explain the return of the BFU-E to preinfection levels and the slight decrease in the CFU-E in the N′Damas. During the acute phase of a T. congolense infection, both the granulomonocytic and erythroid progenitors were increased more effectively in the N′Dama cattle than in the Boran cattle, when compared to the degree of cytopaenia in blood; this might correlate with the superior ability of the N′Damas to maintain higher numbers of granulocytes, monocytes, and erythrocytes in blood.

Adherence to zidovudine (AZT) among HIV-infected methadone patients: a pilot study of supervised therapy and dispensing compared to usual care

Twenty-seven HIV-infected methadone maintenance patients who demonstrated problems adhering to zidovudine (AZT) were randomly assigned to a group that received eight weeks of weekday supervised therapy and dispensing of AZT or a group that received usual care of the clinic. Adherence was assessed by self-report, erythrocyte mean corpuscular volume (MCV), Medication Event Monitoring Systems (MEMS), and pill counts. Subjects in the intervention group demonstrated significantly higher MCV levels during the intervention period than usual care subjects, with similar but non-significant trends for the three other adherence measures. MEMS percent indicated significant group differences on weekdays, but not weekend days. There were no differences at a one-month follow-up. Results suggest supervised therapy and dispensing may be an effective strategy for improving AZT adherence, but only while provided. Further research is needed to establish the effects of larger and longer lasting interventions.

Mechanisms of aluminum-induced microcytosis: Lessons from accidental aluminum intoxication

Twenty-three hemodialysis patients exposed to an accidental aluminum overload, showed increased erythropoietin requirements and decreased erythrocyte mean corpuscular volume (MCV). At the peak of the intoxication, MCV and plasma aluminum levels changed from unrelated (r = 0.02) to strongly related (r = 0.425) variables. The molar proportion of plasma aluminum to plasma iron increased dramatically (from 1:13.8 to 1:2.4). This significant increment in the aluminum/iron ratio made higher the relative offer of aluminum with respect to iron to the erythroid precursor cells. Accordingly, in a subset of 13 randomly selected aluminum-intoxicated patients we found increased intraerythrocytic aluminum, which paralleled the increase in plasma aluminum. Furthermore, in the aluminum-intoxicated group, intraerythrocytic ferritin, a marker of iron content, and the ratio between erythrocyte and plasma ferritin were lower (P < 0.01 and < 0.001, respectively), than in the control group. These findings support the hypothesis that in some cases of aluminum-related microcytosis, a ferropenic mycrocitosis, as expression of erythroid ferropenia, may exist in spite of the presence of normal body iron stores.

COMPARISON OF THE CAGE QUESTIONNAIRE VERSUS SOME BIOCHEMICAL MARKERS IN THE DIAGNOSIS OF ALCOHOLISM

We have compared the individual sensitivity, specificity and predictive value of the CAGE questionnaire, plasma levels of ethanol and acetate, mean corpuscular volume (MCV), gamma glutamyl transferase (GGT), and glycosylated haemoglobin (Hb A1c) in a group of 50 healthy non-alcoholic controls and 31 patients with non-alcoholic liver disease (Group I), and in a second group of 40 alcoholic patients (Group II). Taken individually, the CAGE questionnaire was the most efficient (96% sensitive and 92% specific), followed by plasma levels of acetate (74% sensitive and 85% specific), MCV (64% sensitive and 91% specific) and GGT (72% sensitive and 80% specific). Hb A1c did not show any statistically significant difference between alcoholics and non-alcoholics and thus is of no use as a screening test for the diagnosis of alcoholism. Furthermore, we attempted to design a discrimination procedure to separate alcoholics from controls and patients with non-alcoholic hepatic diseases using a combination of the most promising tests. The most powerful discrimination model was constructed with the four questions of the CAGE questionnaire. The percentage of correct classifications using this model was 99% from Group I (specificity) and 90% from Group II (sensitivity). The CAGE questionnaire was itself so useful as a discriminant in our sample that no increased diagnostic efficacy was noticed on adding any of the other tests. Using objective variables (MCV, acetate and GGT) as discriminants, we could correctly classify 96% of subjects from Group I (specificity) and only 64% from Group II (sensitivity).

Haematologic consequences of viral infections including serum iron status.

Twenty-seven children with mumps or chickenpox were taken as a model to evaluate the haematological consequences of viral infections including serum iron status. Blood samples were obtained from all patients at presentation and on the 21st day of the disease. While haemoglobin, haematocrit, and mean corpuscular volume levels were similar in two measurements (P > 0.05), the mean leucocyte, absolute lymphocyte and thrombocyte counts, mean serum iron, serum iron binding capacity and transferrin saturation levels were lower at presentation than on the 21st day of the disease. The serum iron levels were below 30 micrograms/dl in 16 (59.2%) patients at presentation while only 4 (14.8%) had low values on 21st day. Twenty-four (88.9%) patients had an increment in the serum iron binding capacity levels and 2 (7.6%) reached values above the normal range on the 21st day. In 21 (77.8%) patients, the transferrin saturation levels were below the expected ranges at presentation but 26 (96.3%) showed an increment on the 21st day. However, the mean ferritin level was higher at presentation. Therefore, during the evaluation of patients for anaemia, the presence of a recent acute viral infection should be documented so as to avoid unnecessary iron medication.

The Effect of Zidovudine on Erythrocyte Mean Corpuscular Volume in Asymptomatic HIV-Infected Individuals

Erythocyte mean corpuscular volume (MCV) rises dramatically in the presence of zidovudine, which currently is the only anti-retroviral licensed for the treatment of HIV infected individuals. This paper reports the long-term effects of zidovudine on MCV levels and discusses the potential for using MCV levels as a measure of compliance to study medication in clinical trials of zidovudine.

Cigarette smoking and alcohol consumption as risk factors for aneurysmal subarachnoid hemorrhage.

Aneurysmal subarachnoid hemorrhage is a serious disease despite recent improvements in medical and surgical treatment. Hence, identification of modifiable risk factors for subarachnoid hemorrhage is important. We compared the smoking and drinking habits of 278 consecutive patients with aneurysmal subarachnoid hemorrhage, aged 15-60 years (145 men and 133 women) with those of 314 hospitalized control patients (164 men and 150 women) who did not differ in regard to age, day of onset of symptoms, and acuteness of disease onset. Multiple logistic regression analysis showed that recent alcohol intake and smoking, but not hypertension, were significant independent risk factors for hemorrhage. After adjustment for age, hypertension, and smoking status, men who had consumed 1-40, 41-120, or > 120 g of alcohol within the 24 hours preceding the onset of illness had a relative risk of hemorrhage of 0.3 (95% confidence interval [CI], 0.1-0.8), 2.5 (95% CI, 1.1-5.5), and 4.5 (95% CI, 1.5-12.9), respectively, compared with men who had consumed 0 g. Women who had consumed 1-40 or > 40 g of alcohol had a risk of hemorrhage of 0.4 (95% CI, 0.2-0.8) and 6.4 (95% CI, 2.3-17.9), respectively, compared with women without use of alcohol. Heavily smoking (> 20 cigarettes per day) men and currently smoking women had adjusted relative risks of hemorrhage of 7.3 (95% CI, 3.8-14.3) and 2.1 (95% CI, 1.2-3.6), respectively, compared with men who had never smoked and with women who were not current smokers. Higher levels of erythrocyte mean corpuscular volume in patients with subarachnoid hemorrhage than in control subjects supported the notion of different smoking and drinking habits. Recent heavy alcohol intake and current smoking seem to be independent risk factors for aneurysmal subarachnoid hemorrhage.

MEDICAL RESEARCHES: A RESOURCE FOR ALERTING PARENTS AND CAREGIVERS

Iron deficiency anemia is a nutritional and medical risk factor that has been implicated in lowered developmental scores, as well as increased irritability and solemnity of infants. The present research examined possible further risk correlates of iron deficiency anemia (IDA) in the medical dossiers of 9 to 12 month old infants (M= 10 months) comprising three low‐socioeconomic culture groups, French, African, and North African Muslim, in a Bilan de Sante health clinic in Paris, France. Using a strict dual criteria on measure of IDA: low hemoglobin (Hg ≤ 10.5) and low mean corpuscular volume levels, MCV ≤ 73), a trend was found for increased respiratory disease, such as otitis media and bronchitis, in infants with iron deficiency anemia. Medical monitoring and nutritional informational efforts with families can help prevent iron deficiency anemia and its risk sequelae for infants.

Erythrocyte macrocytosis in infants and children with Down syndrome

Erythrocyte mean corpuscular volume and mean corpuscular hemoglobin levels were higher in children with Down syndrome than in normal control subjects. Reference values for mean corpuscular volume and mean corpuscular hemoglobin level derived from normal populations may be inappropriate for children with Down syndrome. These findings may have important implications for the diagnosis of iron deficiency in these children.

Sickle Cell Disease as a Cause of Osteonecrosis of the Femoral Head

Osteonecrosis of the femoral head is an important complication of sickle cell disease. We studied 2590 patients who were over 5 years of age at entry and followed them for an average of 5.6 years. Patients were examined twice a year, and radiographs of the hips were taken at least twice: at study entry and approximately three years later. At study entry, 9.8 percent of patients were found to have osteonecrosis of one or both femoral heads. On follow-up, patients with the hemoglobin SS genotype and alpha-thalassemia were at the greatest risk for osteonecrosis (age-adjusted incidence rate, 4.5 cases per 100 patient-years, as compared with 2.4 in patients with the hemoglobin SS genotype without alpha-thalassemia and 1.9 in those with the hemoglobin SC genotype). Although the rate of osteonecrosis in patients with the hemoglobin SC genotype did not differ significantly from that in patients with the hemoglobin SS genotype without alpha-thalassemia, osteonecrosis tended to develop in these patients later in life. Intermediate rates of osteonecrosis were observed among patients with the hemoglobin S-beta zero-thalassemia and the hemoglobin S-beta(+)-thalassemia genotypes (3.6 and 3.3 cases per 100 patient-years, respectively). Osteonecrosis was found in patients as young as five years old (1.8 cases per 100 patient-years for all genotypes). The frequency of painful crises and the hematocrit were positively associated with osteonecrosis. The mean corpuscular volume and serum aspartate aminotransferase level were negatively associated. Twenty-seven patients had hip arthroplasty during the study; 10 were under 25 years of age. Five of the 27 required reoperation 11 to 53 months after the initial operation. Osteonecrosis of the femoral head is common in patients with sickle cell disease, with an incidence ranging from about 2 to 4.5 cases per 100 patient-years. Patients with the hemoglobin SS genotype and alpha-thalassemia and those with frequent painful crises are at highest risk. The overall prevalence is about 10 percent. The results of hip arthroplasty are poor.

Cobalamin Deficiency and Red Blood Cell Volume Distribution Width

To the Editor . —I read with interest the recent report by Carmel 1 and the accompanying editorial by Herbert 2 addressing the likely underestimated occurrence of clinically significant cobalamin deficiency. This occurs even in the presence of only mildly depressed serum cobalamin levels, normal or low mean corpuscular volumes, and normal hemoglobin levels. Another piece of information that would have been interesting to know in this series is the red blood cell volume distribution width. The red blood cell volume distribution width is the SD of the mean corpuscular volume of the red blood cell population in question divided by the mean corpuscular volume and expressed as a percentage. 3 Higher values reflect more heterogeneous (anisocytotic) populations of cells. Patients with anemia due to cobalamin deficiencies alone can be expected to have high mean corpuscular volume levels with high red blood cell volume distribution widths, and patients with mixed iron

Ulcer Disease among Geriatric Inpatients with Positive Faecal Occult Blood Test and/or Iron Deficiency Anaemia: A Prospective Study

The purpose of this study was to investigate the prevalence and type of lesions in the upper gastrointestinal tract and to identify characteristics associated with ulcer disease among geriatric inpatients with positive faecal occult blood test and/or iron deficiency anaemia. Two thousand five hundred and four patients aged 60-98 (mean, 82) years admitted to a geriatric clinic for rehabilitation were screened by faecal occult blood test, for B-haemoglobin, and, in a case of anaemia, analyses of serum levels of mean corpuscular volume, mean corpuscular haemoglobin concentration, iron, and total iron-binding capacity. One hundred and seventy patients were included in the study. A high prevalence of ulcer disease (22%) was found. Significantly higher proportions of non-steroidal anti-inflammatory drugs and steroid users and of patients with rheumatoid arthritis and osteoarthrosis were found among ulcer patients than among patients without ulcerative upper gastrointestinal lesions. The clinical picture of ulcer disease differed from the classic presentation: abdominal pain occurred in only 7 of 38 patients (18%), whereas appetite and weight loss and nausea/vomiting were common. It is important to be aware of the high prevalence and the clinical picture of ulcer disease among geriatric inpatients with iron deficiency anaemia and/or occult gastrointestinal bleeding.