A 59-year-old man had been treated twice for iron-deficiency anaemia. Each course of iron improved his haemoglobin, but several months later fatigue returned.
He had no visible bleeding and denied black stools. Appetite was slightly reduced, but there were no dramatic gastrointestinal symptoms.
The question that changed the case
Instead of asking only how to replace iron again, the question became:
Why is an adult man repeatedly becoming iron deficient?
Further gastrointestinal evaluation identified a chronic source of occult blood loss that required definitive treatment.
The diagnostic twist
Iron deficiency is not the final diagnosis. In many adults, especially men and postmenopausal women, the cause must be actively sought.
Clinical pearls
- Treat the deficiency and investigate why it occurred.
- Recurrent iron deficiency deserves evaluation for ongoing blood loss, malabsorption and other causes.
- Improvement with iron confirms response—it does not explain the origin.
Take-home message
When the haemoglobin keeps falling, stop asking only “Which iron?” and start asking “Where is it going?”
Educational note: This is a fictionalized/composite teaching case created for clinical reasoning. It is not a record of an identifiable patient and is not a substitute for local protocols, specialist advice or patient-specific clinical judgement.