Abstract
The diagnosis of iron-deficiency anaemia should initiate investigation into the cause. Gastrointestinal bleeding is the most common cause in men and postmenopausal women, and endoscopic evaluation of patients with iron-deficiency anaemia is useful.
Key Points
Iron-deficiency anaemia is a common condition that is usually identified by the presence of microcytic, hypochromic red cells and characteristic abnormalities of iron studies.
A low serum ferritin level is the most specific serological marker of iron deficiency but it may be elevated in patients with inflammation, liver disease or malignancy.
Faecal occult blood testing (FOBT) is a useful screening test for colon cancer in asymptomatic patients but is rarely useful in the setting of iron-deficiency anaemia.
Initial endoscopic evaluation of patients with iron-deficiency anaemia includes gastroscopy with small bowel biopsy and colonoscopy.
In one-third of patients no cause for iron-deficiency anaemia is found on gastroscopy or colonoscopy and for these patients capsule endoscopy is available on the Pharmaceutical Benefits Scheme within six months of these negative tests.
Iron deficiency in the absence of anaemia is less likely to have a sinister gastrointestinal cause.
Oral iron supplementation is generally well tolerated by patients, and absorption and haematological response are improved by concurrent administration of vitamin C and folate, respectively.
