What initial investigations should I consider for a patient presenting with haematochezia in primary care?

Initial investigations for a patient presenting with haematochezia in primary care should include offering a quantitative faecal immunochemical test (FIT), especially if the patient is aged 50 and over or if they are under 50 with unexplained abdominal pain or weight loss. This test helps to assess the likelihood of colorectal cancer and guides further referral decisions.

Additionally, a full blood count (FBC) should be considered to check for iron-deficiency anaemia, which may indicate colorectal pathology.

A digital rectal examination (DRE) is also recommended to identify any palpable rectal masses or anal abnormalities that may require urgent referral.

If the patient is 50 or older with unexplained rectal bleeding, or under 50 with rectal bleeding plus weight loss or abdominal pain, urgent referral via the suspected cancer pathway should be considered based on FIT results and clinical findings.