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Guidelines for the Management of Iron Deficiency Anaemia in Adults

Updated: 8th September 2021     First published: 11th May 2011


Iron deficiency anaemia (IDA) is a major cause of morbidity worldwide. It can generally be diagnosed from blood tests, and remedied by iron replacement therapy (IRT). The many causes of iron deficiency include poor dietary intake and malabsorption of dietary iron. Because blood is iron-rich, it can alternatively result from chronic blood loss and this is a common mechanism underlying the development of IDA. Approximately a third of men and postmenopausal women presenting with IDA have an underlying pathological abnormality, most commonly in the gastrointestinal (GI) tract.

Optimal management of IDA requires IRT and, where appropriate, investigation to establish the underlying cause. IDA is an accepted indication for fast-track investigation in the UK because GI malignancy can present in this way. It is recommended that unexplained IDA in all at-risk individuals is investigated by endoscopic examination of the upper and lower GI tract, even if there are no other relevant symptoms. In recurrent or refractory IDA, wireless capsule endoscopy to assess the small bowel may be helpful.

IDA may present in primary care or across a range of specialities in secondary care, and because of this and the insidious nature of the condition, it hasn’t always been well-managed – for example, with investigation being slow and/or incomplete. It is therefore important for contemporary guidelines for the management of IDA to be available to all clinicians. This document is a revision of previous BSG guidelines, updated in the light of subsequent evidence and developments.