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

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ModerateFatigueIron deficiency anaemia from occult gastrointestinal blood lossMCCQE Part 1

A 62-year-old man reports fatigue and exertional dyspnoea. Haemoglobin is 88 g/L, MCV is low, ferritin is low and he denies visible bleeding. Which of the following is the most appropriate next step?

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Correct answer: E — Investigate for gastrointestinal blood loss while treating iron deficiency

Iron deficiency anaemia in an older man is gastrointestinal blood loss until proven otherwise and requires evaluation for malignancy or other bleeding sources. Folate does not correct low ferritin microcytosis, and absence of visible bleeding does not exclude occult loss. Iron replacement should occur alongside investigation, not instead of it.

Reference: Canadian Association of Gastroenterology; Choosing Wisely Canada haematology