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Query: UMLS:C0162316 (iron deficiency anemia)
 3,806 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The influence of chronic iron deficiency anaemia on myoglobin content, maximal enzyme activities and capillarization in the human skeletal muscle was investigated. Muscle samples from musculus vastus lateralis were screened in an Indonesian population. The causes of iron deficiency were chronic intestinal bleeding or repeated pregnancy combined with low iron intake. The maximal activities of iron-dependent and non-iron-dependent glycolytic and oxidative enzymes as well as myoglobin showed similar values in the iron-deficient group and the matched control group. The activities of the oxidative enzymes in both the iron-deficient group and the controls were lower, however, compared even to untrained Swedish subjects. The capillary density was essentially within a normal range in both groups. It is concluded that chronic iron deficiency anaemia of a moderate or severe degree, with Hb concentrations of about 80-100 g.1(-1), does not cause an impaired biochemical function of the human skeletal muscle.
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PMID:Effects of chronic iron deficiency anaemia on myoglobin content, enzyme activity, and capillary density in the human skeletal muscle. 337 73

A 31-year-old woman who had been investigated for almost lifelong iron deficiency anaemia caused by chronic gastro-intestinal blood loss was found to have a large cavernous haemangioma of the jejunum. The literature relating to the latter is reviewed and a diagnostic approach to obscure gastro-intestinal bleeding considered.
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PMID:Cavernous haemangioma of the jejunum. A case report and approach to obscure chronic gastro-intestinal bleeding. 348 41

Twenty-two patients with colonic arterio-venous malformations (AVM) are reported and 218 other cases in the English literature are reviewed. Of our patients, 16 (73%) underwent right hemicolectomy because of repeated episodes of rectal bleeding or iron-deficiency anemia. Ten (63%) of these patients have remained in good health with no further evidence of intestinal bleeding after surgery. In six (37%) recurrent episodes of rectal bleeding or iron deficiency anemia have gone unexplained despite thorough work-up including repeat arteriography. Our experience and that in the literature suggests: 1. Most AVM's (78%) occur in the cecum or right colon, the jejunum being the next most common site. 2. Patients with AVM's tend to be elderly with a strong history of cardiovascular disease. A potential association between aortic stenosis, intestinal bleeding, and AVM's is suggested. However, prospective studies are needed to confirm this relationship. 3. In younger patients AVM's tend to occur at atypical sites such as the small bowel. 4. Surgical removal of an AVM cannot be expected to be uniformly curative. The causes of recurrent bleeding after surgery include: incomplete resection of the initial AVM, occult AVM's missed on arteriography and left behind at surgery, and the appearance of new AVM's postoperatively. The cause of bleeding in many patients with recurrence however, remains undiagnosed despite repeat angiography.
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PMID:Arteriovenous malformations of the bowel: an analysis of 22 cases and a review of the literature. 696 39

For this study data from a total of 362 patients covering a time period of 10 years (1979-1989) were analyzed. Referal to the medical outpatient clinic of Zurich occurred in over 90% of the cases for evaluation of incidental iron deficiency anemia or suspected of gastrointestinal bleeding because of melanea/hematemesis. The evaluation comprised endoscopy, in part radiography of the upper intestinal tract and rarely angiography and scintigraphic tracer studies. 95 patients (26%) had benign lesions in the gastro-intestinal tract, 88 patients (26%) had endoscopy without abnormal findings. Iron deficiency was thought to be due to hypermenorrhea in 45 patients (13%) and to other non-gastrointestinal causes in 43 patients (13%) by exclusion. A malignancy of the gastrointestinal tract was found in 25 patients (7%): 18 carcinomas of the colon, 6 carcinomas of the stomach and 1 metastasis of a melanoma to the coecum. In 80% of the patients with malignancies occult fecal blood was detected. In 154 patients (42%) extensive diagnostic investigation including sometimes even repeated endoscopy could not disclose the cause of blood loss. 88 (24%) of these patients had slight iron deficiencies (hemoglobin > 10 g/dl, hemoccult-test positive in 65% of cases), 66 (18%) had severe iron-deficiencies (hemoglobin < 10 g/dl, hemoccult-test positive in 90% of cases). Selective small bowel radiography was performed in 36 patients without any positive findings. Patients with gastro-intestinal bleeding of undetermined etiology present a diagnostic challenge for the general practitioner.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Gastrointestinal hemorrhage: how much evaluation is necessary?]. 827 94

Occult intestinal bleeding was diagnosed in a patient who underwent a distal small bowel resection. The resection was required for small bowel obstruction. She developed iron deficiency anemia four years later. Clinically she presented with melena. Colonoscopy, gastroscopy were unsuccessful in making the diagnosis. But a 99 mass Technetium (99m Tc) Labeled Red Blood Cell (RBC) scintigraphy, established the bleeding site in the gastrointestinal tract. Laparotomy identified an ulcerative lesion at the surgical side-to-side anastomosis. Histology demonstrated focal ulceration with chronic inflammation but did not show crypt abscesses, or granulomata. Medical therapy, including iron and Histamine-antagonists were ineffective. She was treated with resection of the anastomosis. Gastrointestinal bleeding due to anastomotic ulceration appears to be a late complication of small bowel resection with side-to-side anastomosis.
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PMID:Chronic anemia secondary to side-to-side distal small bowel anastomosis. 847 Apr 38

Angiodysplasia, characterized by the presence of malformed vessels in the submucosa of the gastrointestinal tract, may be a cause of recurrent bleeding. Bleeding angiodysplasia can be associated with von Willebrand disease (vWD) and this coincidence is probably the consequence of the lack of high molecular weight molecules of von Willebrand factor in the plasma. We report four patients with unexplained repeated massive intestinal bleeding, recurrent melena and iron deficiency anemia, which required numerous blood transfusions. All patients were adults (average age 68 years). Three patients have congenital von Willebrand disease (type 1, 2A and 3) and one idiopathic acquired von Willenbrand syndrome. Correct diagnosis was made 2-5 years after the onset of the symptoms and was confirmed by histopathological examination of surgically resected small bowel, where vascular lesions were located. Elderly patients with recurrent gastrointestinal bleeding and unexplained iron deficiency anemia should be diagnosed for angiodysplasia and vWD.
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PMID:Angiodysplasia as a cause of recurrent bleeding from the small bowel in patients with von Willebrand disease. Report of 4 patients. 1575 5

Intestinal lymphangiectasia in the adult may be characterized as a disorder with dilated intestinal lacteals causing loss of lymph into the lumen of the small intestine and resultant hypoproteinemia, hypogammaglobulinemia, hypoalbuminemia and reduced number of circulating lymphocytes or lymphopenia. Most often, intestinal lymphangiectasia has been recorded in children, often in neonates, usually with other congenital abnormalities but initial definition in adults including the elderly has become increasingly more common. Shared clinical features with the pediatric population such as bilateral lower limb edema, sometimes with lymphedema, pleural effusion and chylous ascites may occur but these reflect the severe end of the clinical spectrum. In some, diarrhea occurs with steatorrhea along with increased fecal loss of protein, reflected in increased fecal alpha-1-antitrypsin levels, while others may present with iron deficiency anemia, sometimes associated with occult small intestinal bleeding. Most lymphangiectasia in adults detected in recent years, however, appears to have few or no clinical features of malabsorption. Diagnosis remains dependent on endoscopic changes confirmed by small bowel biopsy showing histological evidence of intestinal lymphangiectasia. In some, video capsule endoscopy and enteroscopy have revealed more extensive changes along the length of the small intestine. A critical diagnostic element in adults with lymphangiectasia is the exclusion of entities (e.g. malignancies including lymphoma) that might lead to obstruction of the lymphatic system and "secondary" changes in the small bowel biopsy. In addition, occult infectious (e.g. Whipple's disease from Tropheryma whipplei) or inflammatory disorders (e.g. Crohn's disease) may also present with profound changes in intestinal permeability and protein-losing enteropathy that also require exclusion. Conversely, rare B-cell type lymphomas have also been described even decades following initial diagnosis of intestinal lymphangiectasia. Treatment has been historically defined to include a low fat diet with medium-chain triglyceride supplementation that leads to portal venous rather than lacteal uptake. A number of other pharmacological measures have been reported or proposed but these are largely anecdotal. Finally, rare reports of localized surgical resection of involved areas of small intestine have been described but follow-up in these cases is often limited.
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PMID:Intestinal lymphangiectasia in adults. 2136 42

We studied a patient with edema secondary to protein losing enteropathy, and recurrent bouts of bloating and abdominal pain secondary to intestinal subocclusion episodes. After the clinical study, the patient was diagnosed of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), that is a rare disease, probably caused by mutations in the gene PLA2G4A, and characterized by multiple short stenosis of the small bowel with superficial ulcers, which do not exceed the submucosa layer. Inflammatory bowel disease (Chron's disease), intestinal tuberculosis and intestinal ulcers secondary to non-steroidal anti-inflammatory drugs are the main differential diagnosis. To sum up, physicians should included CMUSE in the differential diagnosis of recurrent abdominal pain, iron deficiency anaemia, occult intestinal bleeding, edema and protein losing enteropathy.
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PMID:Cryptogenia multifocal ulcerous stenosing enteritis: an entity on its own as a cause of abdominal pain, iron deficiency anemia and protein-losing enteropathy. 2403 66

Individuals with colorectal cancer (CRC) have a tendency to intestinal bleeding which may result in mild to severe iron deficiency anemia, but for many colon cancer patients hematological abnormalities are subtle. The fecal occult blood test (FOBT) is used as a pre-screening test whereby those with a positive FOBT are referred to colonscopy. We sought to determine if information contained in the complete blood count (CBC) report coud be processed automatically and used to predict the presence of occult colorectal cancer (CRC) in the setting of a large health services plan. Using the health records of the Maccabi Health Services (MHS) we reviewed CBC reports for 112,584 study subjects of whom 133 were diagnosed with CRC in 2008 and analysed these with the MeScore tool. The odds ratio for being diagnosed with CRC in 2008 was calculated with regards to the MeScore, using cutoff levels of 97% and 99% percentiles. For individuals in the highest one percentile, the odds ratio for CRC was 21.8 (95% CI 13.8 to 34.2). For the majority of the individuals with cancer, CRC was not suspected at the time of the blood draw. Frequent use of anticoagulants, the presence of other gastrointestinal pathologies and non-GI malignancies were assocaitged with false positive MeScores. The MeScore can help identify individuals in the population who would benefit most from CRC screening, including those with no clinical signs or symptoms of CRC.
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PMID:Performance analysis of a machine learning flagging system used to identify a group of individuals at a high risk for colorectal cancer. 2818 47

Heyde syndrome describes the triad of aortic stenosis, acquired coagulopathy, and anemia due to bleeding from intestinal angiodysplasia. An 87-year-old man with iron deficiency anemia due to melena was admitted to our hospital. On examination, a systolic murmur was heard and echocardiography confirmed the presence of aortic stenosis. Esophagogastroduodenoscopy and colonoscopy were unremarkable. Capsule endoscopy and double balloon endoscopy revealed angiodysplasia throughout the small intestine. Laboratory investigations were significant for reduced plasma levels of high molecular weight von Willebrand factor multimers. On the basis of these findings, the patient was diagnosed with Heyde syndrome. The patient required frequent blood transfusions because of the intestinal bleeding, and underwent bioprosthetic aortic valve replacement. Twenty months after the operation, the gastrointestinal bleeding resolved and the patient no longer required blood transfusions. This is the first case report to describe an improvement in bleeding from angiodysplasia, one year after aortic valve replacement. It demonstrates the effective treatment of Heyde syndrome with aortic valve replacement, and highlights the importance of considering this differential diagnosis when evaluating patients presenting with repeated episodes of gastrointestinal bleeding and a concurrent systolic murmur.
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PMID:Aortic Valve Replacement for the Management of Heyde Syndrome: A Case Report. 2897 1


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