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Iron Deficiency Anaemia Investigation — UKMLA MCQ

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MediumGastroenterologyIron Deficiency Anaemia InvestigationUKMLAMRCGP AKTPARAMRCP Part 1PSA

A 66-year-old woman presents with a 6-week history of fatigue, anorexia, and vague upper abdominal discomfort. Blood tests reveal: Haemoglobin 98 g/L (MCV 75 fL), Ferritin 8 ng/mL. What is the most appropriate next investigation according to NICE guidelines?

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Correct answer: A — Upper and lower gastrointestinal endoscopy

Iron deficiency anaemia in a postmenopausal woman (or man of any age) requires investigation to exclude underlying pathology, most commonly gastrointestinal blood loss (e.g., from malignancy, peptic ulcer, angiodysplasia). NICE guidelines recommend urgent referral (2-week wait pathway) for simultaneous upper GI endoscopy and colonoscopy to investigate the entire GI tract in patients aged 60 and over with iron deficiency anaemia. Starting iron without investigation or performing only partial GI investigation is inappropriate. CT scan is not the primary investigation for suspected GI blood loss.

Reference: NICE NG12: Suspected cancer: recognition and referral / CKS: Anaemia - iron deficiency