Question

A 35-year-old woman presents with fatigue and dyspnoea. Full blood count shows Hb 90 g/L, MCV 70 fL and ferritin 6 µg/L. She has regular heavy menstrual bleeding and no gastrointestinal symptoms. What is the most appropriate initial management in general practice?

Accepted Answer

Start oral ferrous iron therapy and investigate for possible gastrointestinal blood loss including coeliac disease serology

Answer

Arrange immediate blood transfusion and refer to haematology, no oral iron

Answer

Start oral vitamin B12 and folate

Answer

Reassure and repeat full blood count in 6 months without treatment

Answer

Refer directly for bone marrow biopsy

Practice question

A 35-year-old woman presents with fatigue and dyspnoea. Full blood count shows Hb 90 g/L, MCV 70 fL and ferritin 6 µg/L. She has regular heavy menstrual bleeding and no gastrointestinal symptoms. What is the most appropriate initial management in general practice?