What initial investigations should be performed for a patient presenting with rectal bleeding in primary care?

Initial investigations for a patient presenting with rectal bleeding in primary care include:

• Perform a thorough history and physical examination, including an abdominal examination and a digital rectal examination if acceptable to the patient, to identify any masses or other abnormalities.
• Offer quantitative faecal immunochemical testing (FIT) for adults aged 50 and over with unexplained rectal bleeding, or adults under 50 with rectal bleeding plus unexplained symptoms such as abdominal pain, weight loss, or iron-deficiency anaemia.
• Check for iron deficiency anaemia with a full blood count, especially in adults aged 60 and over or if symptoms suggest anaemia.
• Consider testing for occult blood in the stool if indicated by symptoms.
• Assess for other causes such as coeliac disease, inflammatory bowel disease, or infections based on history and examination, and refer for further assessment if suspected.

Referral using a suspected cancer pathway should be considered urgently if the patient is aged 50 or over with unexplained rectal bleeding, or if there are additional red flag symptoms or signs such as weight loss, abdominal mass, or iron deficiency anaemia.