Which Anemic Patients Should Be Referred for Colonoscopy?

Older patients with unexplained anemia are often referred for colonoscopy as a first step, but that practice makes sense only when the anemia is caused by iron deficiency. This issue is complicated further by difficulty in distinguishing between the anemias of iron deficiency and chronic disease, both of which affect serum ferritin.

Researchers at the Minneapolis VA Hospital retrospectively compared four groups of patients (nearly all men; mean age, 69) who were referred for colonoscopy — 414 anemic patients, stratified by serum ferritin level into three groups, and a group of 323 nonanemic patients undergoing screening colonoscopy. Anemic patients with abdominal symptoms, documented gastrointestinal bleeding, or no available ferritin levels…