Iron deficiency and iron deficiency anaemia

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Target exams

Red flags

• Iron deficiency anaemia in any man or postmenopausal woman is gastrointestinal disease until proven otherwise — bidirectional endoscopy plus coeliac serology is mandatory unless there is overt non-GI blood loss; the lower the haemoglobin, the more urgent the investigation
• A normal-range ferritin does not exclude iron deficiency — endoscopic yield remains significant at ferritin 40–100 ng/ml even without GI symptoms
• Never treat anaemia with iron alone and close the episode at a normal haemoglobin — continue therapy after normalisation to replete stores, and recheck that stores are full
• Ferric carboxymaltose causes hypophosphataemia in about half of recipients — check phosphate after dosing and prefer alternatives when repeated dosing is anticipated
• Failure of haemoglobin to rise on oral iron is a diagnosis still outstanding: adherence, coeliac disease, H. pylori, ongoing loss — not simply 'more iron'