Historyfocus on

• Duration of symptoms of anaemia—short duration of dyspnoea and fatigue etc. suggests recent bleeding or haemolysis.

• Specific questioning on blood loss—include system-related questions e.g. GIT and gynaecological sources, ask about blood donation.

• Family history—e.g. in relation to hereditary problems such as HS or ethnic Hb disorders such as thalassaemia or HbSS.

• Past history—e.g. association of gastrectomy with later occurrence of Fe and/or B12 deficiency.

• Drug history—including prescribed and non-prescribed medication.

• Dietary factors—mainly relates to folate and Fe deficiency, rarely B12 in vegans. Fe deficiency always occurs because Fe losses exceed intake (it is extremely rare in developed countries for diet to be the sole cause of Fe deficiency).

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