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Iron deficiency anaemia from occult gastrointestinal blood loss — MCCQE Part 1 MCQ

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HardFatigueIron deficiency anaemia from occult gastrointestinal blood lossMCCQE Part 1

A 69-year-old man has haemoglobin 86 g/L, ferritin 5 micrograms/L and new exertional fatigue. He is haemodynamically stable, has no overt bleeding, and takes no anticoagulant. Which plan best addresses both the deficiency and the possibility of occult gastrointestinal malignancy?

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Reveal the answer and explanation

Correct answer: E — Begin iron replacement and arrange timely bidirectional endoscopic evaluation

Begin iron replacement and arrange timely bidirectional endoscopic evaluation: Replacement treats the physiologic deficit while timely gastroscopy and colonoscopy investigate clinically important occult sources. Begin iron replacement and investigate only if haemoglobin fails to rise: A haemoglobin response confirms iron availability but does not exclude malignancy or another bleeding lesion. Transfuse two red-cell units and defer gastrointestinal evaluation until recovery: Stable chronic anaemia does not automatically require transfusion, and transfusion does not determine the cause. Arrange colonoscopy alone because upper gastrointestinal sources are uncommon: Upper gastrointestinal lesions and coeliac disease remain relevant, so colonoscopy alone is incomplete. Arrange faecal immunochemical testing and cancel endoscopy if the result is negative: A negative FIT cannot safely rule out every colorectal or upper gastrointestinal cause of established iron-deficiency anaemia.

Reference: https://academic.oup.com/jcag/article/3/1/36/5248491; https://cancer.ca/en/treatments/tests-and-procedures/colonoscopy; https://cdn.cancer.ca/en/cancer-information/cancer-types/stomach/diagnosis