Iron deficiency anaemia (IDA) is common yet often under-investigated in surgical inpatients, contributing to delayed recovery, transfusion risk, and missed gastrointestinal malignancy. This study examined the prevalence, investigation, and follow-up outcomes of IDA among acute general surgical admissions. A retrospective audit was conducted for all Acute Surgical Unit admissions between January–March 2025. Demographics, haemoglobin, iron studies and endoscopy results were extracted from electronic records. Anaemia was defined using WHO thresholds and IDA as anaemia with ferritin <30 µg/L or transferrin saturation <20%. Patients were excluded if medically unsuitable for endoscopy, post-trauma, pregnant or recently scoped. Descriptive statistics and chi-square testing were performed. Of 866 admissions, 842 patients had bloods available. Anaemia occurred in 174 patients (20%), with 70 meeting biochemical criteria for IDA (8%). IDA patients were older than the total cohort (median 68.5 vs 48 years). Forty patients were appropriate for endoscopic investigation; 20 (50%) were referred, but only 13 procedures occurred within 6 months. Clinically significant pathology was identified in 11/13 cases (85%), including adenomatous polyps (15%) and malignancy (5%). Anaemia severity was not associated with likelihood of referral. IDA was prevalent and frequently under-investigated. Endoscopic yield was high, suggesting missed opportunity for diagnosis and intervention. Routine iron studies for anaemic patients and Direct-to-Scope pathways may improve detection of significant pathology. References World Health Organization 2019, Anaemia. Goddard AF et al. Gut. 2011.