Investigating iron deficiency anaemia

In reply: We appreciate the interest of Bolin and Williams regarding our article.1 We agree that further investigation of iron deficiency anaemia was indicated in this patient, as her clinical presentation of severe, unexplained anaemia is clearly articulated in the Gastroenterological Society of Australia recommendations as requiring such diagnostic investigation, as stated in our article. Colonoscopy would have been the most appropriate investigation. Williams states that all adults with significant iron deficiency anaemia should undergo endoscopy and colonoscopy. While no one would argue that the young woman did not have significant anaemia, there is no agreed definition of what is, or is not, significant. Given the common occurrence of iron deficiency in premenopausal women, prudent physicians and surgeons must consider the necessity for further investigation in each individual, given that dietary deficiency or menstrual loss are much more common than colorectal cancer in young women. This does not mean that young anaemic women should never undergo endoscopy or colonoscopy; it means that clinical judgement, including thorough history-taking, is required in the decision-making process.