Given the fact that “pathologies involving upper and lower GI (gastrointestinal) system
should always be considered during the diagnostic process for IDA (iron deficiency
anaemia)” [
[1]
], gastroduodenoscopy should feature early in the work up of IDA. If no obvious underlying
cause of IDA is found the same gastroduodenoscopy session should be utilised to evaluate
autoimmune gastritis and Helicobacter pylori infection status by gastric biopsy, as
well as Giardia lamblia infestation status and coeliac disease status by duodenal biopsy, instead of considering
those disorders only “in the presence of unexplained recurrent IDA” [
[1]
]. Furthermore, the fact that autoimmune gastritis, H. pylori infection, and Giardia lamblia infestation are risk factors for iron deficiency anaemia [
[1]
], should not undermine awareness that the same aetiological factors also operate for
cobalamin deficiency [
2
,
3
,
4
], and that as many as 25.7% patients with giardiasis may be coinfected with Helicobacter
pylori [
[5]
]. The risk that the diagnosis of coexisting cobalamin deficiency may be missed in
IDA patients is high when microcytosis is the only manifestation of the coexistence
of cobalamin deficiency and iron deficiency [
[2]
]. In the latter study, comprising 160 subjects with autoimmune gastritis, the haematological
profile was characterised by microcytosis (Mean cell volume < 80 fl) in 51.9% of cases. In that study 46% of 83 iron deficient subjects with microcytosis
proved to have coexisting cobalamin deficiency [
[2]
]. Accordingly, early recognition of autoimmune gastritis, H. pylori infection, and Giardia lamblia infestation, respectively, should raise the index of suspicion for the coexistence
of cobalamin deficiency and IDA, thereby mitigating the risk of vitamin B 12-related
neuropsychiatric complications.To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cappellini MD clinical management of iron deficiency anemia in adults: systemic review on advances in diagnosis and treatment.Eur. J. Intern. Med. 2017; 42: 16-23
- Variable hematologic presentation of autoimmune gastritis: age-related progression from iron deficiency to cobalamin depletion.Blood. 2006; 107: 1673-1679
- Hematological manifestations of Helicobacter pylori infection.World J. Gastroenterol. 2014; 20: 12818-12838
- Giardia lamblia infection causes vitamin B12 deficiency.Aust. NZ Med. 1986; 16: 78-79
- Prevalence and predictors of giardia in the United States.Dig. Dis. Sci. 2017; 62: 432-440
- Mean corpuscular haemoglobin, referenced and resurrected.J. Clin. Pathol. 2011; 64: 833-834
- Reticulocyte and erythrocyte hypochromia markers in detection of iron deficiency in adolescent female atheletes.Biol. Sports. 2017; 34: 111-118
- Low mean cell haemoglobin is a reliable marker for iron deficiency screening.Orv. Hetil. 2016; 157 (article in Hungarian, abstract in English): 35-38
Article info
Publication history
Published online: August 09, 2017
Accepted:
July 26,
2017
Received:
July 22,
2017
Identification
Copyright
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.