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Anaemia - iron deficiency - Management
What investigations should I consider?
- Confirm the diagnosis of iron deficiency anaemia, if this has not already been done.
- It is usually unnecessary to investigate the following groups of people prior to treatment:
- Otherwise healthy young people in whom the history clearly suggests a cause (e.g. regular blood donors).
- Menstruating young women with no history of gastrointestinal symptoms or family history of colorectal cancer.
- Pregnant women — investigations (to determine an underlying cause or the presence of complications) are not usually needed if anaemia develops during pregnancy unless the anaemia is severe, the history and examination suggest an alternative cause of iron deficiency (e.g. inflammatory bowel disease), or there is no response to iron supplementation.
- People who are terminally ill or unable to undergo invasive investigations — the appropriateness of investigating people with severe comorbidity (or, in some circumstances, advanced age), especially if management would not be influenced by the results, should be discussed with the person and their family and carers.
- People who refuse further investigations.
- Ideally the likely cause should be documented (e.g. menstruation, frequent blood donation).
- If there is a poor response to empirical iron treatment, or recurrence of anaemia without an obvious cause, the person should be investigated further.
- For other groups of people with iron deficiency anaemia, consider:
- Testing the urine for blood.
- Screening for coeliac disease using coeliac serology (presence of anti-endomysial antibody or tissue transglutaminase antibody).
- Referral for upper and lower gastrointestinal (GI) investigations. For information on when to refer for upper and lower GI investigations, see Referral, or seeking specialist advice.
- Stool examination to detect parasites if appropriate from the person's travel history.
- See the CKS topic on Menorrhagia for information on appropriate investigations if a woman has heavy menstrual bleeding.
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