Thread by @UKGastroDr

A 4️⃣ tweet guide on investigating and managing:

🩸𝗜𝗿𝗼𝗻 𝗱𝗲𝗳𝗶𝗰𝗶𝗲𝗻𝗰𝘆 𝗮𝗻𝗮𝗲𝗺𝗶𝗮 (IDA)

for GPs and non-Gastroenterology colleagues.

Defined as:

🩸Haemoglobin levels
🙎🏻‍♂️< 110 g/L
🙍🏼‍♀️< 100 g/L
with ⬇️ MCV / MCH

#GastroTwearls 1/

New anaemia case:

💉Check haematinics
❗️Don’t forget coeliac screen

Confirm IDA:
✅ ⬇️ ferritin or
✅ ⬇️ transferrin sats or
✅ ⬆️ TIBC & ⬇️ iron 𝘵𝘰𝘨𝘦𝘵𝘩𝘦𝘳

❌ 𝘯𝘰𝘵 ⬇️ serum iron alone (can be anaemia of chronic disease)

🔝Correct ⬇️ B12 / folate

#GastroTwearls 2/

☑️ When confirmed IDA

⚒Start 𝗢𝗡𝗘 iron tablet daily

🩸Ask if bleeding from:

👃🏽Nose, refer 🔜 ENT
🗣Haemoptysis, 🔜 Resp
💧Haematuria, 🔜 Urology

🩲Heavy PV bleeding in menstruating 👩🏻(ask about clots / flooding) or
🩲PV bleeding in menopausal 👩🏼‍🦰
🔜 Gynae

#GastroTwearls 3/

☑️ IDA

With GI symptoms
(PR🩸CIBH 💩 GORD🔥 AP 😖 upper GI 🤢🤮)

Or asymptomatic 🤷🏻‍♂️

Or weight loss ⚖️

🔜Refer to Gastroenterology
‼️2WW if > 55 / 60 (as per local rules)

❕Need coeliac screen result
❔Book CT scan if > 5% wt loss
📅 Pt available if 2WW?

#GastroTwearls end/