Low Rates of Diagnosis and Treatment of Iron Deficiency Anemia After an Acute Severe Gastrointestinal Hemorrhage.

Background: 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. Aims: 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. Methods: 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. Results: 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. Conclusions: 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.