A 62-year-old man has fatigue, microcytic anaemia and a low ferritin. He has no bleeding symptoms. What is the most appropriate next step?
Answer and explanation
Correct answer: A. Investigate the gastrointestinal tract with endoscopy and colonoscopy for occult blood loss
- Step 1: A low ferritin proves iron deficiency, and in an older man the cause is blood loss until proven otherwise. Step 2. The commonest hidden source is the gastrointestinal tract, including colorectal cancer. Answer: Gastrointestinal investigation. Why not the others: B12 deficiency causes macrocytosis. Marrow biopsy is not needed when ferritin is low. Thalassaemia trait has normal or high ferritin.
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