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Iron deficiency anaemia — CCFP MCQ

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HardChronic disease managementIron deficiency anaemiaCCFP

A 66-year-old man presents with fatigue. His hemoglobin is 102 g/L, MCV 72 fL, and ferritin 8 µg/L. He has no visible blood in stool and has never had colorectal screening. What is the most appropriate investigation?

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Correct answer: B — Refer for bidirectional endoscopic evaluation rather than using FIT as the diagnostic test

Canadian practice stipulates that iron deficiency anaemia in elderly men warrants thorough investigation, typically bidirectional endoscopy, to exclude GI malignancy or other significant pathology. Option B reflects best practice. Option A is incorrect—FIT alone is insufficient, as it does not detect upper GI bleeding. Option D (start iron, reassess later) fails to diagnose the cause. Option C (attribute to age) neglects the possibility of malignancy. Option E (wait for abdominal pain) risks delayed diagnosis. Thus, bidirectional endoscopic evaluation is mandatory, per Canadian guidelines.

Reference: College of Family Physicians of Canada (CFPC), Iron deficiency anemia in the elderly, CFP 2015 Feb;61(2):159–162. https://www.cfp.ca/content/61/2/159