Investigations are based on the history and physical examination including the rectal examination. If GIT bleeding is suspected the faecal occult blood is not considered very valuable but appropriate investigations include gastroscopy and colonoscopy, small bowel biopsy and small bowel enema.

Haemological investigations: Typical findings

• microcytic, hypochromic red cells

• anisocytosis (variation in size), poikilocytosis (shape)

• raised iron-binding capacity

• serum ferritin low (the most useful index)

The state of the iron stores is assessed by considering the serum iron, the serum ferritin and the serum transferrin in combination. Typically, in iron deficiency, the serum iron and ferritin are low and the transferrin high, but the serum iron is also low in all infections—severe, mild and even subclinical— as well as in inflammatory states, malignancy and other chronic conditions. Serum ferritin estimations are spuriously raised in liver disease of all types, chronic inflammatory conditions and malignancy; and transferrin is normally raised in pregnancy. Since each of these estimations can be altered in conditions other than iron deficiency, all three quantities have to be considered together to establish the iron status. 2

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