Gastroenterology and hepatology
Iron deficiency, pallor and fatigue
Confirming iron deficiency with ferritin (and when inflammation hides it), who needs gastroscopy and colonoscopy, coeliac and H. pylori testing, alternate-day oral iron, choosing IV iron and its hypophosphataemia risk, and the pale, tired patient.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Iron deficiency is the commonest cause of anaemia worldwide. Many patients are iron deficient before they are anaemic.
- Ferritin under 30 µg/L confirms it. Ferritin is an acute-phase reactant, so inflammation can hide deficiency.
- In men and postmenopausal women, iron deficiency means GI blood loss or malabsorption until proven otherwise. They need gastroscopy and colonoscopy.
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Sources
- American Society of Hematology 2026 guidelines for diagnosis of iron deficiencyPowers JM et al., Blood Adv 2026, 2026
- Therapeutic Guidelines (eTG complete): iron deficiencyAU/NZTherapeutic Guidelines Limited
- Patient Blood Management GuidelinesAU/NZNational Blood Authority Australia
- Guideline on haemoglobin cutoffs to define anaemia in individuals and populationsWorld Health Organization, 2024
- Snook J et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut 2021;70:2030-51British Society of Gastroenterology, 2021
- Ko CW et al. AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology 2020;159:1085-94American Gastroenterological Association, 2020
- Pasricha SR, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet 2021;397:233-48The Lancet, 2021
- Wolf M et al. Effects of iron isomaltoside vs ferric carboxymaltose on hypophosphatemia in iron-deficiency anemia (PHOSPHARE-IDA). JAMA 2020;323:432-43JAMA, 2020
- Last updated
- 14 November 2026
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