Iron deficiency anaemia—a clinical challenge

Iron deficiency anaemia is a common problem both in general and hospital practice. The clinician is often presented with a patient where there are no clinical clues as to the source of the bleeding. The decision to know just how far to investigate these patients can be difficult especially in the elderly and infirm group of patients.

Occasionally a careful dietary history may be valuable but is usually only relevant in a small percentage of patients. Blood loss may be occurring outside the gastrointestinal tract and it is particularly important not to forget the urinary tract and those patients who are taking non-steroidal anti-inflammatory drugs or oral anticoagulants. Furthermore premenopausal women may not admit to excessive menstrual blood loss.

In this month's journal there are two very relevant articles addressing the problem of iron deficiency anaemia. The first is by Dr Jolobe and is primarily concerned with the definition and validation of iron deficiency and the appropriate investigations required to elucidate the underlying cause, particularly in elderly patients. The second paper by Willoughby and Litner retrospectively audits the investigation of iron deficiency anaemia in a district general hospital. It also suggests guidelines for future practice. …