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Injury to gastrointestinal tissue may be a cause of hidden bleeding in patients with iron-deficiency anemia. Damage to the stomach, intestines, colon or other parts of the gastrointestinal system was found in 62 of 100 anemic patients using either endoscopy or colonoscopy. Possible bleeding sites were found in the colons of 25 patients, the gastrointestinal tracts of 36 patients and both in one patient. Cancer was the most common injury to the colon, occurring in 11 of the 26 patients. Nineteen of the 37 patients with identified gastrointestinal bleeding sites had peptic ulcers. The remaining 38 patients with negative results of endoscopy were tested for possible injury using radiography and bowel follow-through studies. Gastrointestinal lesions found in these patients were unlikely to cause bleeding and included small polyps, hemorrhoids, enlarged esophageal veins and inflammation of the esophagus. This group responded well to treatment with iron supplements taken by mouth.

A complex interaction between impaired cardiac performance, activation of neurohormonal and inflammatory responses, renal dysfunction, drug effects, and bone marrow hyporesponsiveness which contribute to the development of anemia is reported. The findings from the study might have merit in patients with moderately symptomatic heart failure and documented iron deficiency.