…and what about the other half? ▸

Investigation of iron deficiency anaemia (IDA) constitutes a significant proportion of a gastroenterologist’s workload and many recent studies have examined the management and outcome of such patients referred to gastroenterologists. However, general practitioners do not refer all of their IDA patients, presumably only those in whom they suspect investigation will be fruitful. This valuable paper analyses the investigation and outcome of IDA presenting in primary care. Cases were identified from the records of two hospital laboratories covering a population of 0.5 million. Over 10 months 431 new cases (men aged >20 years with haemoglobin level <120 g/l; women >50 years with haemoglobin <110 g/l and MCV <78) were identified, of whom only 47% were investigated; 13% were deemed unfit, 8% refused, and for the remainder no reason was evident. At one year, 263 of the 365 cases still alive had no clear diagnosis: two thirds underwent no investigation and in at least 40% anaemia was still evident during follow up. Over the next four years remarkably few (43) …