Tweet

𝗗𝗿 𝗔𝗷𝗮𝘆 𝗠 𝗩𝗲𝗿𝗺𝗮

Feb 27 • 6 tweets • 3 min read

A 4️⃣ tweet guide on investigating and managing:

🩸𝗜𝗿𝗼𝗻 𝗱𝗲𝗳𝗶𝗰𝗶𝗲𝗻𝗰𝘆 𝗮𝗻𝗮𝗲𝗺𝗶𝗮 (IDA)

for GPs & non-Gastroenterology colleagues.

Defined as:

⬇️🩸Haemoglobin levels
(based on your local laboratory reference range)
c̅ ⬇️ MCV / MCH

#GastroTwearls 1/

Check:
💉Haematinics
❗️Coeliac Ab (3-5% of IDA)
🔝treat ⬇️ B12/ folate
❌ no need for FIT

✅ Confirm IDA
⬇️ ferritin or
⬇️ transferrin sats or
⬆️ TIBC 𝘢𝘯𝘥 ⬇️ iron or
⬇️ CHr or
≥ 10 g/L ⬆️ Hb c̅ 2/52 iron

❌ ⬇️ iron 𝘢𝘭𝘰𝘯𝘦 (?anaemia of chronic disease)

#GastroTwearls 2/

☑️ Confirmed IDA

⚒Start 𝗢𝗡𝗘 iron tablet daily

🩸Ask if bleeding from:

👃🏽Nose, refer 🔜 ENT
🗣Haemoptysis 🔜 Resp
💧Haematuria (+ve dip) 🔜 Urology

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

#GastroTwearls 3/

GI symptoms
PR🩸CIBH🧻 GORD🔥 AP😖 upper GI🤢🤮
or
asymptomatic🤷🏻‍♂️

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

❕Need coeliac Ab result
❔Request CT if > 5% weight loss
📅 Pt available if 2WW?

Recurrent IDA (10%) & within 2 yrs
🔜 A&G 💻

#GastroTwearls
4/

@BritSocGastro

Please share 🔁

Feel free to ask questions & discuss 🗣

Want to know more❓🤔
2021 @BritSocGastro IDA guidelines 👇🏼 (I am an author)

gut.bmj.com/content/70/11/…?

https://twitter.com/ukgastrodr/status/1336411189052575751

For more #GastroTwearls 👇🏼
Hope they’re useful!

https://twitter.com/ukgastrodr/status/1336411189052575751

• • •

Missing some Tweet in this thread? You can try to force a refresh

This Thread may be Removed Anytime!

Twitter may remove this content at anytime! Save it as PDF for later use!

More from @UKGastroDr

𝗗𝗿 𝗔𝗷𝗮𝘆 𝗠 𝗩𝗲𝗿𝗺𝗮

@UKGastroDr

May 8, 2021

I have vetted ~3️⃣0️⃣0️⃣ referrals from primary care to Gastroenterology in last 2/52.

Pathways vary around the country - nevertheless I have observations / advice about managing common GI problems in primary care & when to refer in 7️⃣ tweets

#GastroTwearls 1/7

https://twitter.com/UKGastroDr/status/1273736516108537860

Simple GORD does not need an OGD. This is as per national guidance as OGDs aren’t pleasant & rarely changes management.

See #GastroTwearl👇🏼

When giving a PPI, Omeprazole is better than Lansoprazole (fewer SEs) - give a decent dose of 40 mg / day

2/7

https://twitter.com/UKGastroDr/status/1273736516108537860

https://twitter.com/UKGastroDr/status/1355967547548594176

Constipation is really common & poorly recognised. Often a symptom of IBS.

Opioids are a major culprit and cause much misery - give concomitant laxatives.

See #GastroTwearl below for a 4️⃣ tweet guide.

3/7

https://twitter.com/UKGastroDr/status/1355967547548594176

Read 8 tweets

𝗗𝗿 𝗔𝗷𝗮𝘆 𝗠 𝗩𝗲𝗿𝗺𝗮

@UKGastroDr

Oct 31, 2020

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/

Read 4 tweets

𝗗𝗿 𝗔𝗷𝗮𝘆 𝗠 𝗩𝗲𝗿𝗺𝗮

@UKGastroDr

Feb 20, 2020

@RishiSunak

Congratulations @RishiSunak on becoming Chancellor of the Exchequer. You, and your family must be exceptionally proud of your achievements. I can relate to you on some level, we are both of similar ages, and come from similar cultural backgrounds.
/1

The fact that your Dad was a GP & mum was a Pharmacist, means hopefully you can relate to me as a NHS Consultant on some level. Knowing that we are paid relatively well but work hard for this. And that Doctors often work additional hours (or sessions).
/2

These additional sessions, means we get paid more, but ultimately it is to deliver patient services. In fact the NHS is reliant on Consultants & GPs doing additional sessions to keep services running. Examples include extra clinics & operating sessions, or managerial roles.
/3

Read 8 tweets

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Share this page!

𝗗𝗿 𝗔𝗷𝗮𝘆 𝗠 𝗩𝗲𝗿𝗺𝗮

Try unrolling a thread yourself!

More from @UKGastroDr

𝗗𝗿 𝗔𝗷𝗮𝘆 𝗠 𝗩𝗲𝗿𝗺𝗮

𝗗𝗿 𝗔𝗷𝗮𝘆 𝗠 𝗩𝗲𝗿𝗺𝗮

𝗗𝗿 𝗔𝗷𝗮𝘆 𝗠 𝗩𝗲𝗿𝗺𝗮

Did Thread Reader help you today?

Don't want to be a Premium member but still want to support us?

Like this author's thread?