PTU-120 Iron deficiency anaemia in renal cell carcinoma

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Abstract

Introduction

British Society of Gastroenterology (BSG) iron deficiency anaemia (IDA) investigation guidelines recommend urinalysis to screen for non-visible haematuria. If detected, renal ultrasound is recommended to exclude renal cell carcinoma (RCC). Data on IDA in RCC however suggests that haematuria is rarely detected. We sought to identify the prevalence of IDA in RCC, and the frequency of haematuria in this subgroup.

Methods

All newly diagnosed RCC at a single NHS Trust over a 3 year period (1/1/13–31/12/15) were identified from a prospective database of the Urology multidisciplinary meeting (MDM). A retrospective analysis of electronic notes, MDM outcomes, clinic letters, laboratory results, radiology reports, endoscopy reports and histology was undertaken. Information on demographics, symptoms and investigation results were collected. IDA was defined by a combination of microcytosis, hypochromia and low ferritin at time of clinical review, or a diagnosis of IDA on enteral iron replacement prior to clinical review.

Results

There were 163 cases of RCC in 162 patients, mean age 63.7 years, 35% female. 43 patients (26.4%) were anaemic at diagnosis, IDA was present in 22 patients (13.5%). 59% of IDA patients had previously undergone gastrointestinal (GI) endoscopy: one colonic melanoma; all others were normal or benign. Haematuria was reported in 22.1% of RCC patients, and 13.6% of those with IDA (3 patients). Of these 3 patients, 2 had visible haematuria and 1 had non-visible haematuria.

Conclusions

Anaemia is commonly found in patients diagnosed with RCC at presentation. In our study group approximately half of anaemic patients were iron deficient. The majority of these had been previously investigated with GI endoscopy without a significant GI cause identified. Haematuria was not reported in most patients with IDA suggesting urinalysis may not be a suitable screening investigation. This adds further weight to the hypothesis that IDA associated with RCC is not from occult renal tract blood loss but from deposition in, or consumption by, the tumour itself. We propose that renal tract ultrasound is considered in all patients with IDA without significant GI pathology

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