Testing for Gastrointestinal Disorders

Discomfort around the stomach area or gastrointestinal tract could be a sign of a more serious underlying condition that requires immediate attention.

At ACE Specialist Surgery and Endoscopy (ACE), we are determined to help patients identify and resolve the root cause of gastrointestinal disorders. One way is through an anaemia workup, which includes a series of blood tests to provide valuable insights into the body’s current condition.

Led by Senior Consultant General Surgeon Dr. Reyaz Singaporewalla, our experienced team specialises in diagnostic and therapeutic endoscopic procedures to evaluate and safeguard your gastrointestinal health. 

What is Anaemia?

Anaemia is a common condition that affects millions of people worldwide. It occurs when there is a significant decrease in red blood cells (RBCs) or haemoglobin (right), compared to normal levels (left).

This can lead to symptoms like fatigue, weakness, dizziness, and shortness of breath. In fact, according to the World Health Organization, over 1.6 billion people globally suffer from anaemia, making it a major health concern.

For individuals experiencing these symptoms, an anaemia workup is essential. This process involves a thorough evaluation to determine the underlying cause of anaemia, whether it’s due to iron deficiency, vitamin deficiencies, chronic disease, or other factors. Early detection through a detailed workup can significantly improve treatment outcomes, helping patients regain their energy and well-being.

Understanding the importance of anaemia diagnosis and addressing the root causes can lead to long-term health improvements and prevent potential complications.

What is an anaemia workup?

An anaemia workup involves a series of diagnostic tests to determine the cause of anaemia. These include:

1. Blood Tests

• Complete Blood Count (CBC): Confirms anaemia by measuring haemoglobin, haematocrit, and RBC counts.
• Iron Studies: Includes serum iron, ferritin, total iron-binding capacity (TIBC), and transferrin saturation to assess iron levels.
• Serum Vitamin B12 and Folate Levels: Check for deficiencies that could cause anaemia due to malabsorption in the digestive system.

2. Imaging Studies

• Endoscopy (Upper Endoscopy and Colonoscopy): Visualises the gastrointestinal tract to identify bleeding sources or other abnormalities causing anaemia.

3. Bone Marrow Examinations

• Bone Marrow Biopsy: Used in cases of severe or unexplained anaemia to assess bone marrow function and identify potential bone marrow disorders.

Although the core aims of an anaemia workup are to confirm the presence of anaemia and determine its nature, this series of tests can sometimes be used to detect the underlying cause(s) of certain gastrointestinal disorders. This is due to the fact that gastrointestinal disorders can cause chronic inflammation, chronic blood loss and poor nutrient absorption which eventually leads to a decrease in red blood cells or haemoglobin levels¹.

Is an anaemia workup suitable for me?

Patients whose current treatments are not helping with their persistent gastrointestinal discomfort may be recommended to do an anaemia workup. This is because the workup may determine the underlying cause of their gastrointestinal symptoms, aiding both diagnosis and management of the condition².

Indications of a gastrointestinal cause of anaemia can include:

• Chronic abdominal pain
• Bloating
• Changes in bowel habits
• Unexplained weight loss
• Visible blood in the stool (or black, tarry stools)
• Positive stool occult blood test during health screen

Benefits of anaemia workup

• Identification of hidden GI Bleeding
• Assessment of nutrient absorption
• Accurate diagnosis
• Guiding effective treatment plans
• Prevention of complications
• Enhanced quality of life

What gastrointestinal disorders can be identified?

Anaemia workups can help patients identify the source of their discomfort around the gastrointestinal tract area due to gastrointestinal disorders, such as:

• Gastrointestinal bleeding: Patients with gastrointestinal bleeding may present with anaemia, which can be detected through an anaemia workup. Our general surgeon in Singapore can suggest further investigations to locate and treat the source of the bleeding.
• Gastric (stomach)  ulcers: Patients with gastric ulcers may experience chronic blood loss and abdominal pain and discomfort after eating. This condition is often indicated by low haemoglobin levels and confirming the presence of an ulcer through a gastroscopy procedure.
• Duodenal ulcer and its complications: Patients with acute or chronic duodenal ulcers, may experience either acute blood loss via vomiting blood or passing black tarry stools. Sometimes, the blood loss is slow and chronic, resulting in chronic iron deficiency anaemia. A thorough blood workup and endoscopic evaluation is crucially needed to identify the cause and to prevent further complications like perforation and obstruction from stenosis. 
• Gastroesophageal reflux disease (GERD): Patients with GERD may develop oesophagitis as a result of acid reflux, which can lead to chronic blood loss from erosions in the lower oesophagus ( food pipe ).  This condition often manifests in the anaemia workup as iron deficiency anaemia.
• Diverticular disease of intestine: Patients with colonic Diverticuli may experience either massive blood loss with painless passing of large amounts of fresh blood from the anus with resulting acute anaemia or chronic occult blood loss in stools, resulting in chronic iron deficiency anaemia. This condition can often be detected through anaemia workup, providing guidance for our healthcare providers to further examine the site through colonoscopy and relevant treatment plans. 
• Abdominal pain: Patients with abdominal pain may have an underlying cause of anaemia resulting from gastric or intestinal ulcers or bleeding tumours, which can be identified with anaemia workups such as gastroscopy and colonoscopy. The test results can help determine the appropriate treatment plans conducted by our healthcare providers.

Anaemia workups for patients with gastrointestinal disorders are particularly beneficial in finding hidden sources of bleeding, inflammation, or nutrient malabsorption. Accurate test results help our general surgeon formulate effective treatment plans for the root cause of discomfort, thus minimising patients’ discomfort and improving their overall well-being².

How should I prepare for an anaemia workup?

Preparing for an anaemia workup is fairly simple. Patients may be asked to fast for a certain period before their blood is taken to ensure an accurate representation of results. They might also be asked to stop taking medications, supplements or vitamins temporarily before taking the test as these can alter the result of blood tests. Lastly, patients should keep a detailed record of their symptoms, including their duration and frequency, especially regarding discomfort in their gastrointestinal tracts.

Will the procedure be uncomfortable?

The procedure is generally well-tolerated by patients. Blood will be drawn from patients through syringes, which might temporarily cause slight discomfort. Our general surgeon might also recommend imaging procedures such as endoscopy or colonoscopy to further examine the gastrointestinal tract for bleeding or inflammation sources. Patients might be recommended to undergo bone marrow biopsy to assess their bone marrow function if needed. 

Our skilled and experienced clinic staff will ensure that patients are kept informed at every step of the procedure to provide clarity, comfort, and peace of mind.

Step-by-Step: The Anaemia Workup

1. Medical History and Physical Exam

The first step in diagnosing anaemia is gathering a detailed medical history. The general surgeon will ask about the following:

• Symptoms such as fatigue, shortness of breath, dizziness, and weakness.
• Dietary habits, focusing on iron, B12, and folate intake.
• Family history of anaemia or blood disorders.
• Any history of blood loss due to surgeries, injuries, or menstruation.

A physical exam is also performed to check for signs of anaemia, such as paleness (especially in the skin and conjunctiva), jaundice, or an enlarged spleen, which could indicate hemolysis or other blood disorders³.

2. Blood Tests

Blood tests are the cornerstone of the anaemia workup. They help identify the type and severity of anaemia and provide clues about its cause.

• Complete Blood Count (CBC): A CBC measures red blood cells, haemoglobin, hematocrit, and other blood components. It reveals whether the patient is anaemic and whether the anaemia is mild, moderate, or severe.
• Reticulocyte Count: This test measures the number of young red blood cells (reticulocytes) being produced. A low reticulocyte count suggests the body isn’t making enough red blood cells, while a high count may indicate active destruction or loss of red blood cells.
• Iron Studies: These include serum iron, ferritin (which reflects iron stores), total iron-binding capacity (TIBC), and transferrin saturation. Low ferritin and iron levels typically point to iron deficiency anaemia, the most common form.
• Vitamin B12 and Folate Levels: A deficiency in either of these vitamins can lead to megaloblastic anaemia, a condition in which red blood cells are larger than normal and do not function properly. Testing for these vitamins helps identify nutritional causes of anaemia.
• Other Blood Markers: Depending on the suspected cause, tests for inflammatory markers, kidney function, or other specific biomarkers (such as lactate dehydrogenase or bilirubin) may be included to detect hemolysis or chronic conditions.

3. Advanced Investigations

In cases where blood tests are inconclusive or suggest a more complex cause, additional diagnostic procedures may be recommended:

• Peripheral Blood Smear: A blood smear is examined under a microscope to assess the size, shape, and colour of red blood cells. This can help differentiate between various types of anaemia, such as iron deficiency, sickle cell anaemia, or megaloblastic anaemia.
• Gastroscopy and  Colonoscopy: If anaemia is suspected to be caused by chronic blood loss or there is a history of obvious bleeding from the gastrointestinal tract, gastroscopy and colonoscopy will be needed to detect ulcers, polyps, or tumours that might be causing bleeding.
• Imaging Studies: In some cases, imaging studies such as an abdominal CT scan, CT angiography or capsule endoscopy may be conducted to assess and pinpoint the exact source and location of internal bleeding that could contribute to anaemia.

By following these steps, a general surgeon can accurately diagnose the cause of anaemia and tailor treatment to address the root issue, whether it's iron deficiency, chronic disease, or other underlying conditions.

What happens after an anaemia workup?

After patients have done the anaemia workup, our doctor will discuss the results with them and recommend a tailored treatment plan. This might include the prescription of iron supplements, vitamin B12 injections, and dietary changes. After more invasive procedures such as bone marrow biopsy, patients might be advised to restrict strenuous activities for several days to speed up the healing process. Our general surgeon might also recommend patients book follow-up appointments to monitor their condition and make necessary adjustments to their treatment plans⁴.

Are there any side effects? What is the typical recovery time?

The side effects of anaemia workup are usually minimal. Blood tests may cause slight bruising and discomfort at the site of injection that will eventually go away within several days. If a bone marrow biopsy is done during, signs of soreness and tenderness might be present at the biopsy site though it is usually mild and can go away within several days. To speed up the healing process, patients should allow the body to rest for a few days and minimise strenuous activities.

When will I know the results?

The time taken to receive the results can vary depending on the types of tests the patient took. Blood test results are usually available within a few days. On the other hand, bone marrow biopsy results might take longer. At ACE Specialist Surgery and Endoscopy, we make sure to inform patients of when to expect the availability of test results. We will also schedule a follow-up appointment to further discuss results and treatment plans. 

How often should I repeat an anaemia workup?

The frequency of anaemia workup depends on each patient’s initial results and treatment plans which they have discussed with our doctor. If necessary, periodic anaemia workups might be scheduled to evaluate ongoing conditions, especially when chronic gastrointestinal disorder or blood loss is present. Otherwise, repeating the workup is only necessary if symptoms of anaemia occur again or there are significant changes in the patient’s health that needs to be further investigated.

Visit ACE if you have gastrointestinal concerns

To uncover and treat any underlying gastrointestinal issues effectively, please schedule an appointment with ACE Specialist Surgery and Endoscopy today. Our Senior Gastrointestinal specialist, Dr. Reyaz Singaporewalla, will assess your condition and determine if an anaemia workup is beneficial for you.

References:

1. Ko CW, Siddique SM, Patel A, et al. AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anaemia. Gastroenterology. 2020;159(3):1085-1094. doi:10.1053/j.gastro.2020.06.046
2. Schop A, Stouten K, Riedl JA, et al. A new diagnostic work-up for defining anaemia etiologies: a cohort study in patients ≥ 50 years in general practices. BMC Fam Pract. 2020;21(167):1-9. doi: 10.1186/s12875-020-01241-7
3. Vyas N, Hendren S, Sehgal DMT, et al. The Accuracy of Physical Examination to Diagnose Anaemia  Among Patients Five Years or Older: A Systematic Review. Indian J Hematol Blood Transfus. 2023;39(1):90-101. doi: 10.1007/s12288-022-01543-z
4. Kumar A, Sharma E, Marley A, et al. Iron deficiency anaemia: pathophysiology, assessment, practical management. BMJ Open Gastroenterol. 2022;9(e000759):1-9. doi: 10.1136/bmjgast-2021-000759