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Deceitful red-flag: angina secondary to iron deficiency anaemia as a presenting complaint for underlying malignancy
  1. Chanaka Aravinda Perera1,
  2. Richard Peter Biggers2 and
  3. Alan Robertson3
  1. 1 Department of Medicine, Ninewells Hospital, Dundee, UK
  2. 2 Foundation Training School, East of Scotland, Perth Royal Infirmary, Perth, UK
  3. 3 Department of Cardiology, Ninewells Hospital, Dundee, UK
  1. Correspondence to Dr Richard Peter Biggers, r.biggers1{at}


A 73-year-old man with an 8-week history of angina underwent an exercise tolerance test at the rapid access clinic, which indicated inducible ischaemia and he was subsequently referred for angiogram. His angiogram demonstrated no coronary pathology. It was later discovered that bloods taken on the day of the procedure showed a haemoglobin of 54 g/L (130–180 g/L). His haemoglobin used to book the angiogram 3 months before was 143 g/L. Following angiogram, a mass was identified in the right iliac fossa and CT scan confirmed a caecal tumour. The patient ultimately underwent a curative right hemicolectomy as an outpatient. The case is a reminder of the importance of basic preangiogram investigations, in particularly a full blood count, to rule-out angina secondary to anaemia through a low haemoglobin. Most importantly, it also questions when the appropriate time is for these investigations to be carried out, prior to coronary angiography.

  • interventional cardiology
  • colon cancer

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  • Contributors CAP and RPB established plan for this case report and consented the patient. RPB drafted the case presentation to follow-up and CAP drafted the discussion and performed the initial literature review for similar cases. First draft was then discussed with AR who made changes on this and discussed areas for improvement, then discussion re-drafted by both CAP and RPB to produce the final piece with changes made again by AR. All three parties agreed on the final draft for submission and the revision of that draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.