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dc.contributor.authorJohannsdottir, Gudrun Arna
dc.contributor.authorOnundarson, Pall T
dc.contributor.authorGudmundsdottir, Brynja R
dc.contributor.authorBjornsson, Einar Stefan
dc.date.accessioned2013-08-27T10:04:06Z
dc.date.available2013-08-27T10:04:06Z
dc.date.issued2012-09
dc.date.submitted2013-08-27
dc.identifier.citationThromb. Res. 2012, 130(3):e20-5en_GB
dc.identifier.issn1879-2472
dc.identifier.pmid22633210
dc.identifier.doi10.1016/j.thromres.2012.05.005
dc.identifier.urihttp://hdl.handle.net/2336/299931
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links field.en_GB
dc.description.abstractThe prevalence and etiology of occult bleeding among patients on warfarin who are screened systematically for new anemia is largely unknown. We aimed to estimate the usefulness of following hemoglobin and mean red cell volume (MCV) with INR in order to screen for developing anemia as an indicator of occult bleeding. All patients on warfarin controlled at our institution had measurements of complete blood count (CBC) with INR during 18 months. Patients who fell>25 g/L and/or decrease of MCV over 5 fL or MCV<80 fL were contacted with instructions to undergo evaluation of anemia. Overall 3218 patients on warfarin were monitored at our institution and 442 (13.7%) had anemia and 235 (7.3%) had unexplained anemia. A total of 163/235 (69%) who were notified contacted their doctors and 82/163 (50%) were referred for investigation with upper and/or lower endoscopies. Gastrointestinal malignancies were found in 11 patients (10 colorectal cancers, 1 esophageal) and pre-cancerous lesions among 14 other patients. Additional 25/82 patients (30%) had upper and/or lower bleeding lesions such as ulcers and angiodysplasia. Based on 3669 years of observation, 73 patients needed to be screened for one year in order to identify one gastrointestinal lesion causing occult bleeding. Thirty percent of those endoscoped had malignant or pre-malignant diseases. Regular measurement of CBC concomitantly with INR in patients on warfarin therapy led to detection of otherwise asymptomatic diseases in a significant proportion of patients and might lead to earlier diagnosis of malignant and premalignant disease.
dc.language.isoenen
dc.relation.urlhttp://dx.doi.org/10.1016/j.thromres.2012.05.005en_GB
dc.relation.urlhttp://www.sciencedirect.com/science/article/pii/S0049384812002277en_GB
dc.rightsArchived with thanks to Thrombosis researchen_GB
dc.subject.meshAdolescenten_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshAnemiaen_GB
dc.subject.meshAnticoagulantsen_GB
dc.subject.meshBlood Cell Counten_GB
dc.subject.meshChilden_GB
dc.subject.meshDrug Toxicityen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshGastrointestinal Neoplasmsen_GB
dc.subject.meshHumansen_GB
dc.subject.meshIcelanden_GB
dc.subject.meshIncidenceen_GB
dc.subject.meshInternational Normalized Ratioen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMass Screeningen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshPrecancerous Conditionsen_GB
dc.subject.meshPrevalenceen_GB
dc.subject.meshRisk Assessmenten_GB
dc.subject.meshWarfarinen_GB
dc.subject.meshYoung Adulten_GB
dc.titleScreening for anemia in patients on warfarin facilitates diagnosis of gastrointestinal malignancies and pre-malignant lesions.en
dc.typeArticleen
dc.contributor.departmentDepartment of Internal Medicine, University of Iceland School of Health Sciences, Reykjavik Iceland.en_GB
dc.identifier.journalThrombosis researchen_GB
dc.rights.accessNational Consortium - Landsaðganguren
html.description.abstractThe prevalence and etiology of occult bleeding among patients on warfarin who are screened systematically for new anemia is largely unknown. We aimed to estimate the usefulness of following hemoglobin and mean red cell volume (MCV) with INR in order to screen for developing anemia as an indicator of occult bleeding. All patients on warfarin controlled at our institution had measurements of complete blood count (CBC) with INR during 18 months. Patients who fell>25 g/L and/or decrease of MCV over 5 fL or MCV<80 fL were contacted with instructions to undergo evaluation of anemia. Overall 3218 patients on warfarin were monitored at our institution and 442 (13.7%) had anemia and 235 (7.3%) had unexplained anemia. A total of 163/235 (69%) who were notified contacted their doctors and 82/163 (50%) were referred for investigation with upper and/or lower endoscopies. Gastrointestinal malignancies were found in 11 patients (10 colorectal cancers, 1 esophageal) and pre-cancerous lesions among 14 other patients. Additional 25/82 patients (30%) had upper and/or lower bleeding lesions such as ulcers and angiodysplasia. Based on 3669 years of observation, 73 patients needed to be screened for one year in order to identify one gastrointestinal lesion causing occult bleeding. Thirty percent of those endoscoped had malignant or pre-malignant diseases. Regular measurement of CBC concomitantly with INR in patients on warfarin therapy led to detection of otherwise asymptomatic diseases in a significant proportion of patients and might lead to earlier diagnosis of malignant and premalignant disease.


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