López-García Yadith Karina, Colunga-Pedraza Perla Rocío, Tarín-Arzaga Luz, López Garza Mariana Itzel, Jaime-Pérez José Carlos, Gómez-Almaguer David
a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González' , Universidad Autónoma de Nuevo León , Monterrey , Mexico.
Hematology. 2018 Oct;23(9):658-663. doi: 10.1080/10245332.2018.1461290. Epub 2018 Apr 11.
To determine the referral patterns and etiology of iron deficiency anemia (IDA) at an academic hematology center in northeast Mexico.
We included all consecutive outpatients older than 16 years, non-pregnant, with IDA diagnosed in the Hematology Service of the Dr. José E. González University Hospital between January 2012 and May 2017. Appropriate data were collected retrospectively from the electronic medical record. Data regarding first medical contact (primary care physician or hematologist) were compared.
One hundred fifty-three patients were included in this study. The median age was 43 years (interquartile range, 35-51) and 85.6% were female; 128 (83.7%) patients were seen by a primary care physician before our evaluation. Abnormal uterine bleeding (AUB) was the cause of IDA in 76 patients (49.6%), gastrointestinal bleeding (GIB) in 31 (20.2%), H. pylori infection in 12 (7.8%), urinary tract bleeding in three (1.9%) and malabsorption-syndrome in two (1.3%). The etiology remained unknown in 29 (18.9%). The p value was <0.05 between groups according to the first medical contact, including frequency of at least one sign or symptom of IDA, previous use of iron supplementation and blood transfusion, comorbidities, complete blood count at diagnosis, and resolution rates of anemia.
The majority of our IDA patients were referred by another physician. Nearly half of the patients with IDA had AUB. IDA remains a diagnostic challenge for first contact physicians requiring a targeted educational intervention to improve IDA awareness and diagnostic skills.
确定墨西哥东北部一家学术血液学中心缺铁性贫血（IDA）的转诊模式和病因。
我们纳入了2012年1月至2017年5月期间在何塞·E·冈萨雷斯博士大学医院血液科诊断为IDA的所有连续的16岁以上非妊娠门诊患者。从电子病历中回顾性收集相关数据。比较首次医疗接触（初级保健医生或血液科医生）的数据。
本研究共纳入153例患者。中位年龄为43岁（四分位间距，35 - 51岁），85.6%为女性；128例（83.7%）患者在我们评估前已由初级保健医生看过。76例（49.6%）患者的IDA病因是异常子宫出血（AUB），31例（20.2%）是胃肠道出血（GIB），12例（7.8%）是幽门螺杆菌感染，3例（1.9%）是泌尿道出血，2例（1.3%）是吸收不良综合征。29例（18.9%）患者的病因仍不明。根据首次医疗接触分组，包括至少一种IDA体征或症状的频率、既往铁剂补充和输血的使用情况、合并症、诊断时的全血细胞计数以及贫血缓解率，组间p值<0.05。
我们的大多数IDA患者是由其他医生转诊的。近一半的IDA患者有AUB。IDA对首次接触的医生来说仍然是一个诊断挑战，需要有针对性的教育干预来提高对IDA的认识和诊断技能。
