A 59-year-old man has iron deficiency anaemia with ferritin 8 micrograms/L and no obvious cause. What is the most appropriate next step?
Answer and explanation
Correct answer: B. Investigate the gastrointestinal tract for a source of bleeding or malignancy
- Step 1: In older men iron deficiency suggests GI blood loss until proven otherwise.
- Step 2: NICE NG12 advises investigating for colorectal cancer.
Answer
Investigate the gastrointestinal tract for a source of bleeding or malignancy.
Why not the others: A bone marrow biopsy first: Marrow biopsy is not first-line. Oral iron tablets alone, with no further investigation unless the anaemia persists: Treatment without a cause misses cancer. A repeat full blood count in a year, once the iron tablets have been completed: A year's delay is unsafe.
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