Iron deficiency anemia referral to the hematologist. Real-world data from Mexico: the need for targeted teaching in primary care

Objectives: To determine the referral patterns and etiology of iron deficiency anemia (IDA) at an academic hematology center in northeast Mexico. Methods: We included all consecutive outpatients older than 16 years, non-pregnant, with IDA diagnosed in the Hematology Service of the Dr. Jose E. Gonzalez University Hospital between January 2012 and May 2017. Appropriate data were collected retrospectively from the electronic medical record. Data regarding first medical contact (primary care physician or hematologist) were compared. Results: One hundred fifty-three patients were included in this study. The median age was 43 years (interquartile range, 35-51) and 85.6% were female; 128 (83.7%) patients were seen by a primary care physician before our evaluation. Abnormal uterine bleeding (AUB) was the cause of IDA in 76 patients (49.6%), gastrointestinal bleeding (GIB) in 31 (20.2%), H. pylori infection in 12 (7.8%), urinary tract bleeding in three (1.9%) and malabsorption-syndrome in two (1.3%). The etiology remained unknown in 29 (18.9%). The p value was <0.05 between groups according to the first medical contact, including frequency of at least one sign or symptom of IDA, previous use of iron supplementation and blood transfusion, comorbidities, complete blood count at diagnosis, and resolution rates of anemia. Conclusion: The majority of our IDA patients were referred by another physician. Nearly half of the patients with IDA had AUB. IDA remains a diagnostic challenge for first contact physicians requiring a targeted educational intervention to improve IDA awareness and diagnostic skills.