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Paper of the Day- Haemaglobin threshold too low in CRC referral guidelines

The current threshold for anaemia in the colorectal cancer two week referral (TWR) criteria is set too low and risks missing malignancies, suggest new UK research.

Gastroenterologists at the University Hospital of North Tees in Stockton-on-Tees reviewed all 143 cases of colorectal cancers seen in the hospital between January 2003 and June 2004.

Anaemia was defined according to their local practice (Hb less than 12.0 g/dl in females and 13.0 g/dl in males), compared with the threshold recommended in the national referral guidelines (Hb less than 10 g/dl in females and 11 g/dl in males).

Anaemia was present in 48% of males and 50% of females using local practice and 24% of males and 16% of females using national referral guidelines.

Those with right-sided and non-rectal cancers were significantly more likely to be anaemic than those with left-sided and rectal cancers, respectively.

They conclude: "The current threshold for anaemia at which national guidelines suggest referral also appears to be insensitive".

In approximately half the cases a diagnosis of colorectal cancer is not associated with anaemia and anaemia is more common with proximal lesions – they add - but this is not a consistent finding.

Colorectal Disease 2007;9(8):736-739

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