Abnormal iron absorption is a well recognised feature of subtle non-bleeding gastrointestinal conditions, such as coeliac disease or atrophic body gastritis, without otherwise gastrointestinal symptoms. We recently observed a patient with severe iron deficient anaemia mimicking impaired iron absorption in the absence of gastrointestinal pathology.

A 47 year old women was admitted to hospital in 2005 because a haemoglobin level of 6.4 g/dl had attracted attention when she was donating blood. She complained of fatigue and occasionally frontal headaches. On physical examination she appeared to have a normal nutritional condition but her skin was pale and she had brittle nails. Despite the severity of the anaemia she appeared well. Pulse frequency and blood pressure were normal. Blood smear showed a strikingly microcytotic hypochromic red blood cell …