Update on iron deficiency anaemia

Iron deficiency anaemia (IDA) is often picked up on blood tests. This review says that the most important causes to exclude are colonic or gastric cancer and coeliac disease. Other important points include

• Serum ferritin is the most powerful test for iron deficiency
• Consider upper and lower GI investigations in all postmenopausal women and all male patients
• All patients should be screened for coeliac disease
• Unless the diagnosis of gastric cancer or coeliac disease is clear, lower GI investigation is needed
• The best lower GI investigation is colonoscopy, CT colography is second best, and barium enema comes a poor third
• Faecal occult blood testing is of no benefit in investigating IDA
• Rectal examination is seldom helpful and, in the absence of symptoms such as rectal bleeding or tenesmus, may be postponed until colonoscopy
• Urine testing for blood is important in the examination of patients with IDA.

Source: Gut 2011;60:1309-1316