Practical Management of Anaemia After a Gastrointestinal Bleed

Abstract

Prof Gralnek presented a clinical case on the management of gastrointestinal bleeding (GIB) as a result of Helicobacter pylori infection, and the role of intravenous (IV) ferric carboxymaltose (FCM) as a treatment option for iron deficiency anaemia (IDA) was discussed. IV iron is suitable for patients who have intolerance or limited or no response to oral iron, haemoglobin (Hb) <10 g/dL, or Hb >10 g/dL with cardiovascular or respiratory comorbidities. Prof Gralnek stressed that IDA is common, often underdiagnosed and undertreated, and that the choice between oral or IV iron therapy depends on the degree of anaemia, presence of inflammation, and adherence to oral iron therapy. The main objective of iron treatment is to normalise Hb and iron parameters, and gastroenterologists need to be more aware of anaemia beyond the acute GIB episodes. Prof Lanas presented a clinical case on the management of patients taking anticoagulants (AC) or antithrombotics (AT) who have anaemia due to GIB, and highlighted challenges associated with reducing the risk of bleeds while avoiding thrombotic events. Prof Lanas highlighted clinical dilemmas arising from stopping, restarting, and switching AC in patients with anaemia and GIB, as well as Hb management at discharge. He also stressed that GIB, and especially anaemia or iron storage depletion, are frequently encountered in patients taking AT, and may have a direct impact on mortality, morbidity, and quality of life (QoL). Anaemia and iron deficiency affect mortality, recovery, and QoL in patients who need a rapid restoration of Hb levels and iron stores to decrease the risk of cardiovascular events. Prof Lanas concluded by explaining that FCM therapy has a favourable safety profile, and is more effective, faster, and cost-effective compared to oral iron therapy, and therefore represents a good therapeutic option for anaemic GIB patients with elevated risk of thrombosis.