When should a menstruating woman with iron-deficiency anemia be referred for GI workup? — KELLY DUCHAR, PA-C, Greenville, S.C.

Iron-deficiency anemia in a postmenopausal woman warrants GI workup if no other cause is known. Occult indolent GI cancers are the most common cause of iron-deficiency anemia in this age group. In a premenopausal woman, the iron-deficiency anemia may be more likely attributable to blood loss. Patients should be worked up to confirm iron deficiency as the cause of the anemia.

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Encouragement of an iron-fortified diet and treatment with iron supplements should correct the deficiency. If a premenopausal woman continues to be anemic despite iron supplements, further investigation is recommended. — Claire Babcock O’Connell, MPH, PA-C (150-4)