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IDA in Elderly Male — RACP Adult Medicine MCQ

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EasyHaematologyIDA in Elderly MaleRACP Adult Medicine

A 75-year-old man presents with fatigue and Hb 95 g/L, MCV 72 fL (microcytic). Ferritin is 8 μg/L, TSAT 8%. He has no obvious source of bleeding. Faecal immunochemical test (FIT) is positive. He has never had a colonoscopy. What is the most important next investigation?

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Correct answer: C — Colonoscopy plus upper GI endoscopy

Iron deficiency anaemia (low ferritin, low TSAT, microcytic) in a man over 50 with positive FIT mandates urgent bidirectional endoscopy (colonoscopy AND OGD) to exclude GI malignancy. Right-sided colon cancers classically present with iron deficiency anaemia without overt bleeding. Iron replacement should be commenced but must NOT delay endoscopic investigation. Coeliac serology should also be checked as a cause of iron malabsorption.

Reference: Cancer Council Australia – 2024; eTG Haematology 2024; BSG 2024