skip to main content

Iron Deficiency in Treated Celiac — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

EasyGeneral Internal MedicineIron Deficiency in Treated CeliacRACP Adult Medicine

A 45-year-old woman with celiac disease well-controlled on a GFD develops iron deficiency anaemia despite adequate dietary iron intake. Her tTG antibodies are negative confirming dietary compliance. What should be investigated?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — All of the above

While celiac disease itself can cause iron deficiency (malabsorption), persistent iron deficiency despite a strict GFD with negative serology requires a comprehensive evaluation. Potential causes include: (1) excessive menstrual blood loss (common in premenopausal women); (2) occult GI blood loss (colon cancer screening – even in celiac patients, other GI pathology can coexist); (3) persistent villous atrophy despite GFD (refractory celiac); (4) associated autoimmune conditions affecting iron metabolism; (5) dietary inadequacy despite GFD. Simply attributing persistent iron deficiency to celiac disease without further investigation risks missing a serious diagnosis.

Reference: eTG – 2025 – Gastrointestinal; eTG – 2025 – Haematology