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An unexpected cause of iron deficiency
  1. Thomas Edward Conley1,
  2. Timothy Andrews2,
  3. Arvind Arumainathan3,
  4. Paul O'Toole1,
  5. Philip J Smith1,
  6. Sreedhar Subramanian1
  1. 1Gastroenterology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
  2. 2Histopathology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
  3. 3Haematology, Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
  1. Correspondence to Dr Thomas Edward Conley, Gastroenterology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool L7 8XP, UK; thomasconley{at}

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Clinical presentation

A 70-year-old man presented with progressive weight loss and intermittent lower abdominal pain. Bowel habit was unchanged, there was no overt blood loss and there were no constitutional symptoms. His medical history included vascular Parkinson’s, hypertension, osteoarthritis, type 2 diabetes mellitus and colonic polyps. His medications included pantoprazole and clopidogrel.

On physical examination, his abdominal and digital rectal examinations were unremarkable. Laboratory tests revealed normocytic (mean cell volume 84.1 fL) hypoferritinaemia (15 μg/L) with low haemoglobin (123 g/L). Coeliac serology, other haematinics and immunoglobulin profile were normal. Urinalysis excluded haematuria.

Gastroscopy and duodenal biopsies were normal and urease test was negative for Helicobacter pylori. CT colonography identified a 22 mm proximal sigmoid lesion with a depressed centre concerning for extension beyond the …

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  • Correction notice This article has been corrected since it published Online First. A typographical error in the title has been amended.

  • Contributors TEC and SS were involved in drafting and final revision of the manuscript. TEC, SS, TA, AA, PO and PJS were involved in editing and approval of the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.