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Iron deficiency anaemia from occult GI bleeding — MCCQE Part 1 MCQ

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ModerateFatigueIron deficiency anaemia from occult GI bleedingMCCQE Part 1

63-year-old man presents with progressive fatigue and exertional dyspnoea. Haemoglobin is 82 g/L with microcytosis and ferritin is low; he has not had colorectal screening. Which of the following is the most appropriate next step?

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Correct answer: D — Investigate iron deficiency with gastrointestinal evaluation while replacing iron

Investigate iron deficiency with gastrointestinal evaluation while replacing iron is best because iron deficiency anaemia in an older man is gastrointestinal blood loss until proven otherwise. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Do not attribute new iron deficiency in an older adult to diet alone.

Reference: Canadian Association of Gastroenterology guidance