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Investigating iron deficiency anaemia

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Persistent unexplained iron deficiency should always be investigated, but iron deficiency is common and colorectal cancer rare in young women — the risks of investigation must be balanced against the risks of serious pathology

We would like to express our sympathy to the family and to acknowledge the tragedy of the circumstances in regard to the death of their 29-year-old family member from metastatic colon cancer.

To summarise, the woman presented at the age of 22 years with severe iron deficiency anaemia (IDA) and fatigue but no history of excessive menstrual blood loss. She underwent gastroscopy to test for coeliac disease; colonoscopy was not performed. She was treated with iron supplementation over 6 months, although her father notes that her iron reserves remained depleted. Tragically, she later presented with metastatic colon cancer.

The patient’s father notes that current guidelines for the management of patients with IDA indicate that, in premenopausal women, gastrointestinal (GI) investigation should be reserved for those with colonic symptoms, a strong family history or persistent IDA after iron supplementation and correction of potential causes. From our understanding, the young woman had persisting IDA despite…