Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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Anaemia with shock, cardiac symptoms or continuing haemorrhage
Syncope, chest pain, breathlessness at rest, haemodynamic compromise or rapidly falling haemoglobin requires urgent assessment; transfusion decisions depend on clinical state rather than ferritin alone.
Action: Call for emergency senior and anaesthetic help, begin ABCDE care, obtain large-bore intravenous access, crossmatch, full blood count, coagulation and renal tests, and treat active haemorrhage while arranging urgent source control. Make a senior red-cell transfusion decision from shock, myocardial symptoms, ongoing loss and comorbidity; oral iron is not the immediate treatment for compromised perfusion.
Synopsis
Confirm iron deficiency, judge physiological urgency, replace iron and investigate the source in parallel, with particular attention to occult gastrointestinal loss and objective response to treatment.
Confirm deficiency with ferritin and transferrin saturation interpreted beside CRP; microcytosis alone is insufficient.
Send quantitative FIT and coeliac serology before referral in a new unexplained adult IDA pathway, while treating physiological urgency immediately.
FIT at or above 10 micrograms per gram supports the relevant urgent cancer pathway for upper and lower GI assessment.
Key red flags
Syncope, chest pain, breathlessness at rest, haemodynamic compromise or rapidly falling haemoglobin requires urgent assessment; transfusion decisions depend on clinical state rather than ferritin alone.
Investigation priorities
01
Full blood count, reticulocytes and blood filmFirst step
characterise anaemia and look for alternative or combined haematological processes
Management branches
Worked case: applied iron-deficiency anaemia and occult gi blood lossReach a specific decision and confirm it happened
A 66-year-old man has fatigue, haemoglobin 92 g/L, ferritin 7 micrograms/L, normal blood pressure and no visible bleeding. Coeliac serology is negative and quantitative FIT returns 38 micrograms haemoglobin per gram.
Confirm stable physiology and absence of chest pain, syncope or breathlessness at rest, allowing an urgent outpatient rather than resuscitation pathway.
Review blood count, ferritin, transferrin saturation and CRP and take medication, donation, dietary, family and gastrointestinal histories with abdominal and rectal examination.
Symptomatic severe anaemia pathwayStabilise before routine replacement monitoring
A patient with ongoing melaena has haemoglobin 54 g/L, pulse 124/min, chest pain, cool peripheries and systolic pressure 86 mmHg.
Key medicines
Ferrous sulphate 200 mg tabletGive one 200 mg tablet by mouth once daily, providing about 65 mg elemental iron; if gastrointestinal adverse effects prevent adherence, consider one tablet on alternate days, another oral preparation or intravenous iron according to urgency and absorption.Warn about nausea, constipation, diarrhoea and dark stool; separate from medicines and foods that reduce absorption when clinically relevant. Consider intravenous replacement when oral iron is ineffective, not tolerated or unlikely to be absorbed.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.