Patients with iron deficiency anaemia which is not explained by non-GI causes (such as menorrhagia, haematuria or haemoptysis) should be referred for gastro-enterological investigations.

These patients need upper GI and lower GI endoscopies, if they are fit enough to undergo endoscopy.

The main causes for their iron deficiency will be:

a) poor oral intake
b) poor iron absorption (e.g. coeliac disease)
c) GI blood loss.

Pre-referral investigations: FBC, U&E, serum ferritin or serum iron, coeliac screen (tissue transglutaminase antibody)

Pre-referral treatment: ferrous fumarate

Referral threshold: Two Week Wait rules apply – to see these, click on the 2WW tab at the top of this page. Use the Lower GI rather than the Upper GI 2WW form, unless there are associated isolated upper GI symptoms