El-Halabi Mustapha M, Green Michael S, Jones Christopher, Salyers William J
Mustapha M El-Halabi, Michael S Green, Christopher Jones, William J Salyers Jr, Department of Internal Medicine, University of Kansas School of Medicine - Wichita, Wichita, KS 67214, United States.
World J Gastrointest Pharmacol Ther. 2016 Feb 6;7(1):139-44. doi: 10.4292/wjgpt.v7.i1.139.
To determine whether patients hospitalized with gastrointestinal (GI) blood loss anemia are being checked and treated for iron deficiency.
Retrospective chart review was conducted for all patients admitted to a single tertiary care hospital between 11/1/2011 and 1/31/2012 for any type of GI bleeding. The primary endpoint was the percentage of patients who had their iron studies checked during a hospitalization for GI blood loss anemia. Secondary outcomes included percentage of anemic GI bleeders who had adequate documentation of anemia and iron deficiency, and those who were treated for their iron deficiency. Then we tried to identify possible predictors of checking iron studies in an attempt to understand the thought process that physicians go through when managing these patients. Iron deficiency was defined as Iron saturation less than 15% or ferritin level less than 45 μg/L. Anemia was defined as hemoglobin level less than 13 g/dL for males and 12 g/dL for females.
Three hundred and seven GI bleeders were hospitalized during the study period, and 282 of those (91.9%) had anemia during their hospital stay. Ninety-five patients (30.9%) had iron studies performed during hospitalization, and 45 of those (47.4%) were actually found to be iron deficient. Only 29 of those 45 iron deficient patients were discharged home on iron supplements. Of the 282 patients that had anemia during hospitalization, 50 (17.7%) had no documentation of the anemia in their hospital chart. Of the 45 patients that had lab proven iron deficiency anemia (IDA), only 22 (48.5%) had documentation of IDA in at least one note in their chart. Predictors of checking iron studies in anemic GI bleeders were lower mean corpuscular volume, documentation of anemia, having fecal occult blood testing, not having hematemesis or past history of GI bleeding. There were no significant differences between the teaching and non-teaching services in any patient characteristics or outcomes.
Iron deficiency is under-diagnosed, under-recognized even when iron studies were checked, and under-treated in hospitalized patients with GI bleeding.
确定因胃肠道（GI）失血贫血住院的患者是否接受了缺铁检查及治疗。
对2011年11月1日至2012年1月31日期间入住一家三级医疗中心医院的所有因任何类型GI出血的患者进行回顾性病历审查。主要终点是因GI失血贫血住院期间接受铁代谢检查的患者百分比。次要结果包括有贫血和缺铁充分记录的贫血性GI出血患者百分比，以及接受缺铁治疗的患者百分比。然后我们试图确定检查铁代谢的可能预测因素，以了解医生在管理这些患者时的思维过程。缺铁定义为铁饱和度低于15%或铁蛋白水平低于45μg/L。贫血定义为男性血红蛋白水平低于13g/dL，女性低于12g/dL。
研究期间有307例GI出血患者住院，其中282例（91.9%）住院期间患有贫血。95例患者（30.9%）在住院期间进行了铁代谢检查，其中45例（47.4%）实际被发现缺铁。这45例缺铁患者中只有29例出院时带铁补充剂回家。在282例住院期间患有贫血的患者中，50例（17.7%）在医院病历中没有贫血记录。在45例经实验室证实为缺铁性贫血（IDA）的患者中，只有22例（48.5%）在病历的至少一条记录中有IDA记录。贫血性GI出血患者检查铁代谢的预测因素是平均红细胞体积较低、贫血记录、进行粪便潜血试验、无呕血或无GI出血既往史。教学服务组和非教学服务组在任何患者特征或结果方面均无显著差异。
缺铁在因GI出血住院的患者中诊断不足、即使进行了铁代谢检查也认识不足且治疗不足。
