Iron deficiency anaemia

Yield for significant pathology varies considerably between iron deficiency and IDA even in patients aged over 50.

CRC risk in IDA with negative QFIT is very low <1% (Tayside,Fife and Lothian data)

• Individuals with IDA should be referred for appropriate GI investigations if sufficiently fit to undergo them
• Localising symptoms should direct investigation to upper GI endoscopy or colon test
• Patients without localising symptoms should be referred for a colon test

• Appropriate investigation will be at the discretion of the secondary care team and will depend on a patient’s age and general fitness
• CT colonography will be offered to patients age >70 and less fit patients or those who cannot tolerate colonoscopy*
• Minimal prep CT (no purgative laxative preparation) will be reserved for the most frail patients where any investigation at all is appropriate*
• *It is useful to have up to date U&E’s for frail patients or those >80 years

Who not to refer: 

GI investigations are not appropriate in other types of anaemia unless there are clear GI symptoms to be investigated

• Menstruating females should not undergo GI investigation in the absence of GI symptoms or a family history of colon cancer
• Testing for Coeliac disease is appropriate in these patients

How to refer:

To refer for upper GI endoscopy:

Borders General Hospital -> Endoscopy -> Endoscopy B

To refer for colon test:

Borders General Hospital -> Borders colon service

(See Borders Colon Service page for further information)

Patients can be started on oral iron (ferrous sulphate, ferrous fumarate, or ferrous gluconate) one tablet once per day. This can be started prior to investigations. If this is not tolerated, then reducing to one tablet on alternative days can be considered. Initial treatment can be continued for 3 months.

Oral iron maintenance is now recommended to be one tablet every other day instead of every day.

For patients unable to tolerate oral iron that still require it intravenous iron can be arranged by GPs via the infusion suite. This is not a first line treatment and oral iron should be trialled initially.

Scenario: Management | Management | Anaemia - iron deficiency | CKS | NICE

bor.gastroenterology@borders.scot.nhs.uk