Colonic Varices and Anemia

Yes, colonic varices can cause anemia through chronic, intermittent blood loss that may lead to iron deficiency anemia. 1

Mechanism of Anemia in Colonic Varices

Colonic varices can cause recurrent episodes of hematochezia (rectal bleeding) of varying degrees, which may lead to iron deficiency anemia through chronic blood loss 2
The bleeding from colonic varices may be intermittent and sometimes occult (not visibly apparent), leading to chronic anemia rather than always presenting as massive hemorrhage 3
In severe cases, bleeding from colonic varices can cause significant drops in hemoglobin levels, with reported cases showing hemoglobin as low as 2.1 g/dL 2

Complete blood count with red blood cell indices (MCV, RDW), reticulocyte count, differential blood cell count, serum ferritin, transferrin saturation, and CRP concentration should be performed to assess the type and severity of anemia 1
In patients without inflammation, serum ferritin <30 μg/L or transferrin saturation <16% defines iron deficiency 1
In the presence of inflammation, serum ferritin up to 100 μg/L may still be consistent with iron deficiency 1
If serum ferritin is between 30-100 μg/L with evidence of inflammation, a combination of true iron deficiency and anemia of chronic disease is likely 1

In patients with anorectal varices and severe bleeding, hemoglobin should be maintained at a level of at least >7 g/dL (4.5 mmol/L) during the resuscitation phase 1
A restrictive packed red blood cell transfusion strategy improves survival in Child-Pugh A and B patients with variceal bleeding 1
Avoid fluid overload during resuscitation as it may exacerbate portal pressure and increase the risk of further bleeding 1

Ano-proctoscopy or flexible sigmoidoscopy is recommended as the first-line diagnostic tool for suspected bleeding anorectal varices 1
In patients with high-risk features or evidence of ongoing bleeding, urgent colonoscopy (plus upper endoscopy) should be performed within 24 hours 1
Full colonoscopy should be considered in patients with risk factors for colorectal cancer or suspicion of a more proximal bleeding source 1

Local endoscopic procedures (endoscopic variceal ligation, band ligation, sclerotherapy, or EUS-guided glue injection) should be used to arrest bleeding where feasible 1
Non-selective beta-adrenergic blockers may be considered for prevention/prophylaxis of first and/or recurrent variceal bleeding 1, 4
Vasoactive drugs such as terlipressin or octreotide can be used to reduce splanchnic blood flow and portal pressure 1
In cases of treatment failure, a "step up" approach with radiological (embolization) and then surgical procedures may be necessary 1

Iron supplementation should be initiated when iron deficiency anemia is present 1
The choice between oral, intramuscular, or intravenous iron supplementation depends on symptoms, severity, and comorbidities 1
For mild anemia (Hb >10 g/dL), oral iron supplementation at 100 mg/day may be adequate 1
More severe anemia may require intravenous iron supplementation, especially if there are gastrointestinal adverse effects from oral iron 1

Colonic varices can be idiopathic or secondary to portal hypertension, with more than 75% of cases being due to portal hypertension 3
Recurrent bleeding from colonic varices can lead to chronic anemia requiring long-term management 5
In rare cases, colonic varices may be associated with syndromes like Klippel-Trenaunay syndrome, which can present with rectal bleeding and chronic anemia 5
Balloon-occluded retrograde transvenous obliteration (BRTO) may be considered as an alternative treatment for colonic varices when traditional techniques are unsuccessful or contraindicated 6