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Anaemia

Anaemia from a Gastrointestinal Perspective

Definition
  • Anaemia is defined as a reduction in haemoglobin concentration in the blood, leading to reduced oxygen-carrying capacity.
Classification
  • Microcytic: MCV <80 fL
  • Normocytic: MCV 80-100 fL
  • Macrocytic: MCV >100 fL
Gastrointestinal Causes

Microcytic Anaemia:

  • Iron-deficiency anaemia: Most commonly due to chronic GI blood loss (e.g. peptic ulcers, colorectal carcinoma, angiodysplasia).
  • Malabsorption of iron: coeliac disease, atrophic gastritis, and post-gastrectomy.

Macrocytic Anaemia:

  • Vitamin B12 deficiency: Often due to pernicious anaemia, gastrectomy, or conditions causing malabsorption like Crohn’s disease affecting the terminal ileum.
  • Folate deficiency: Often due to coeliac disease, medications (e.g., methotrexate), and excessive alcohol intake.

Normocytic Anaemia:

  • Chronic disease: Chronic inflammation in conditions such as inflammatory bowel disease (IBD) can lead to anaemia of chronic disease.
  • Acute bleeding: e.g., from a ruptured oesophageal varix or diverticular bleed.
Investigations
  • Full blood count (FBC): Determines type of anaemia.
  • Iron studies: Ferritin, serum iron, total iron-binding capacity (TIBC), transferrin saturation.
  • Endoscopy and colonoscopy: Identify sources of GI bleeding.
  • Coeliac serology: In suspected malabsorption or iron-deficiency anaemia without clear cause.
  • Stool tests: For occult blood.
  • Vitamin B12 and folate levels: To diagnose deficiency.
Management
  • Address underlying cause: E.g., treating peptic ulcers, removing colorectal carcinoma, or starting a gluten-free diet in coeliac disease.
  • Iron supplementation: In iron-deficiency anaemia. Consider both oral and intravenous routes.
  • Vitamin B12 and folate supplementation: In their respective deficiencies.
  • Transfusion: May be required in cases of severe or symptomatic anaemia.

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