Iron-deficiency anaemia — adult assessment

PLAB 2 & PRES 3 · haematology · medium · 8 minutes

Candidate brief

You are a doctor in a GP practice. Mr Michael Turner, 63, has returned to discuss blood tests arranged because of fatigue and breathlessness on exertion. His haemoglobin is 96 g/L, MCV 72 fL and ferritin 7 micrograms/L. Explain the results, assess possible causes and agree an appropriate investigation and management plan. No physical examination is required, but verbalise any examination or investigations you would perform.

What examiners look for

Iron-deficiency anaemia is confirmed by anaemia with evidence of depleted iron stores, commonly a low ferritin. Do not assume iron deficiency in an adult man or postmenopausal woman is caused only by diet. Chronic gastrointestinal blood loss, cancer, ulcers, medicines, coeliac disease and other causes must be considered. Ask about visible and hidden bleeding, bowel and upper-GI symptoms, haematuria, medicines such as NSAIDs, diet, blood donation and malabsorption. UK mode uses FIT within the current colorectal-cancer referral pathway. A negative FIT does not identify the cause of anaemia or exclude upper-GI disease. Unexplained IDA commonly requires assessment of both the upper and lower gastrointestinal tract. This may involve gastroscopy and colonoscopy or alternative imaging when appropriate. Start iron replacement while investigations proceed unless there is a specific reason not to. Oral iron is commonly started once daily; alternate-day treatment may improve tolerability. Check the haemoglobin response within 2 to 4 weeks. Continue iron for approximately 3 months after haemoglobin normalises to replenish iron stores. Oral iron may cause nausea, abdominal discomfort, constipation, diarrhoea and dark stools. Keep iron securely away from children because overdose can be fatal.

Guideline references

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