An unusual rectal polyp.

symptom. Liver function tests are often normal, with one study showing two-thirds of precirrhotic cases and one-third of cirrhotic cases having normal tests at diagnosis.' A number of studies have examined the usefulness of a variety of investigations in the assessment of patients presenting with chronic fatigue in general practice. In general such investigations have not proved useful as only a low yield of abnormal results has been found. However, such studies have not included screening tests for haemochromatosis and sometimes not even liver function tests.5 Iron stores in haemochromatosis are promoted by a diet rich in red meat and vitamin C and depleted by any cause of blood loss.2 It is often wrongly thought that premenopausal women are protected from iron overload and organ damage by menstruation and the requirements of pregnancy. However this patient, who had cirrhosis due to haemochromatosis at diagnosis only four years after the menopause, illustrates that even combined blood loss due to blood donation and menstruation may not prevent iron accumulation and subsequent organ damage. Venesection is required to deplete and maintain iron stores at the lower limit of Summary points