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Abbreviations: Hb, hemoglobin; MCV, mean corpuscular volume; RDW, red cell distribution width; FEP, free erythrocyte protoporphyrin; TIBC, total iron-binding capacity,?, abnormally high; 4, abnormally low; N, normal.

Abbreviations: Hb, hemoglobin; MCV, mean corpuscular volume; RDW, red cell distribution width; FEP, free erythrocyte protoporphyrin; TIBC, total iron-binding capacity,?, abnormally high; 4, abnormally low; N, normal.

In addition to making a diagnosis of iron-deficiency anemia, its pathogenesis must be established. The history should include conditions resulting in low iron stores at birth, dietary history, and consideration of all factors leading to blood loss. The most common site of bleeding is into the bowel, and the most important investigation is examination of the stool for occult blood. If occult blood is found, its cause should be established by examination of stools for ova, rectal examination, barium enema, upper GI series, 99mTc-pertechnetate scan for detection of a Meckel's diverticulum, upper endoscopy, and colonoscopy.

Negative guaiac tests for occult bleeding may occur if bleeding is intermittent; for this reason, occult bleeding should be tested for on at least five occasions when GI bleeding is suspected. The guaiac test is only sensitive enough to pick up more than 5 mL occult blood. Excessive uterine bleeding, epistaxis, renal blood loss (hematuria), and, on rare occasions, bleeding into the lung (idiopathic pulmonary hemo-siderosis and Goodpasture syndrome) may all be causes of iron-deficiency anemia. Bleeding into these areas requires specific investigations designed to detect the cause of bleeding.

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