Lin Elissa S, Dutson Usah, Jensen Dennis M
David Geffen School of Medicine at UCLA.
VA GI Hemostasis Research Unit at West Los Angeles VA Medical Center.
Res Sq. 2024 Nov 11:rs.3.rs-5307617. doi: 10.21203/rs.3.rs-5307617/v1.
Few studies report about management of iron deficiency anemia after a severe, acute gastrointestinal bleed. Most include good risk patients with upper gastrointestinal bleeds and report only laboratory improvements but not clinical outcomes.
To assess management of iron deficiency anemia and clinical outcomes of patients after a severe, acute gastrointestinal bleed from either upper or lower sources in an unselected group of patients.
Retrospective analysis of adult patients hospitalized with severe gastrointestinal bleeding in two referral centers. They had endoscopic diagnoses of lesions including non-variceal upper, variceal, and lower sites (diverticulosis or other colon sources). Analyses were of rates of iron studies ordered and iron treatments up to 4 months post discharge. Composite clinical outcomes were also assessed and analyzed.
For 337 patients studied, iron studies were ordered in only 50%. When tested, iron deficiency was diagnosed in 75% of anemias. Intravenous iron or oral iron was prescribed in only 7.1% and 26.7% of patients respectively. By 4 months, 94% of patients treated with intravenous iron and 80% treated with oral iron achieved ≥ 2 g/dL increase in hemoglobin level. Patients with high rates of severe comorbidities and severe anemia had poorer clinical outcomes than others with severe anemia and less comorbidity.
Despite significant anemia after a severe gastrointestinal bleed from common diagnoses, iron studies were not routinely ordered. Iron deficiency anemia was infrequently recognized or treated with iron therapies. Patients with severe co-morbidities and anemia after an acute gastrointestinal bleed had poor clinical outcomes.
很少有研究报道严重急性胃肠道出血后缺铁性贫血的管理情况。大多数研究纳入的是上消化道出血风险较低的患者，且仅报告了实验室指标的改善情况，而非临床结局。
评估一组未经筛选的患者发生上消化道或下消化道严重急性胃肠道出血后缺铁性贫血的管理情况及临床结局。
对两家转诊中心因严重胃肠道出血住院的成年患者进行回顾性分析。他们经内镜诊断有病变，包括非静脉曲张性上消化道、静脉曲张性和下消化道部位（憩室病或其他结肠来源）。分析出院后4个月内进行铁代谢检查的比率和铁剂治疗情况。还对综合临床结局进行了评估和分析。
在研究的337例患者中，仅50%进行了铁代谢检查。检查时，75%的贫血患者被诊断为缺铁。分别仅有7.1%和26.7%的患者接受了静脉铁剂或口服铁剂治疗。到4个月时，接受静脉铁剂治疗的患者中有94%、接受口服铁剂治疗的患者中有80%血红蛋白水平升高≥2 g/dL。严重合并症发生率高和重度贫血的患者临床结局比其他重度贫血且合并症较少的患者更差。
尽管常见诊断的严重胃肠道出血后存在明显贫血，但铁代谢检查并非常规进行。缺铁性贫血很少被识别或采用铁剂治疗。急性胃肠道出血后有严重合并症和贫血的患者临床结局较差。
