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  1. Tony Todd, specialist registrar in haematology1,
  2. Tim Caroe, portfolio general practitioner2
  1. 1Addenbrooke's Hospital, Cambridge CB2 2QQ
  2. 2General Practice and Primary Care Research Unit, University of Cambridge
  1. Correspondence to: T Todd tony.todd{at}addenbrookes.nhs.uk

    A 40 year old woman with persistent fatigue has come back to you for the results of blood tests. The results show a hypochromic, microcytic anaemia with a haemoglobin concentration of 100 g/l and a ferritin concentration of 5 µg/l, the classic features of iron deficiency anaemia (IDA).

    What issues you should cover

    Symptoms of anaemia

    Fatigue and mild dyspnoea after exertion may be the only symptoms in otherwise healthy people with slow onset anaemia. More serious symptoms such as angina, marked ankle oedema, or dyspnoea at rest don't generally occur unless the haemoglobin concentration is less than about 70 g/l. Presence of such symptoms in a case like this indicate additional cardiorespiratory pathology.

    Causes of the anaemia

    Blood loss—Seek any history of haemorrhage. In the 5-10% of premenopausal women who develop IDA the commonest cause is menorrhagia. For reliable assessment simple pictogram charts may be better than subjective reporting.

    Coeliac disease—In younger patients coeliac disease often …

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