Aim of the assessment Unexplained iron deficiency anaemia in men and postmeno-pausal women is a 'red flag' presentation and if no cause is found will require a suspected colorectal cancer pathway referral according to recent National Institute for Health and Care Excellence (NICE) cancer guidelines. Consider why the patient may be anaemic (Box 1) and look for other 'red flag' symptoms and signs that suggest serious underlying conditions, such as cancer. Remember that iron deficiency anaemia is often multi-factorial. History of the presenting complaint Find out what Mrs Jones already knows about the blood tests and die reasons for doing them. When explaining the results, establish what she knows about anaemia and what she thinks the underlying problem may be. Does she have any particular concerns, such as cancer worries? Does she have any expectations with regard to Rather investigations or treatment? Does she have any underlying conditions that may cause her to lose blood or become iron deficient (Box 1)? Find out if she has any symptoms. If so, how do these affect her daily life? Shortness of breath, for example, can be disabling. Rapidly developing anaemia may cause significant symptoms, whereas gradual blood loss may go unnoticed, even at surprisingly low haemoglobin levels. Ask about other general symptoms of chronic anaemia, such as breathlessness, lack of energy and worsening angina, which may be a presenting symptom in patients with underlying cardiovascular disease. Does she experience gastrointestinal 'red flag' symptoms, for example dyspepsia, rectal bleeding or a change in bowel habit? Has she noticed any abnormal bleeding from her vagina or blood when passing urine?
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