Investigations	Potential results	Clinical management plan: abnormal results

Check haemoglobin, RBC indices and platelets Check clotting and haematinics if heavy bleeding has occurred	Abnormal	Follow treatment for abnormal blood results (pages 2–3).
Flexible sigmoidoscopy	Radiation proctopathy with bleeding from telangiectasia	*Do not biopsy* irradiated areas. Optimise bowel function and stool consistency. If bleeding is not affecting quality of life, reassure. If bleeding affects quality of life, stop/reduce anti-coagulants if possible and consider sucralfate enemas (page 19). Discuss referral to a specialist centre for treatment to ablate telangiectasia (pages 18–19): a. hyperbaric oxygen therapy b. intra-rectal formalin b. thermal therapy, eg, APC Consider referral to a specialist centre for experimental therapy within the context of a clinical trial: thalidomide, vitamin A, tranexamic acid, RFA.
	Haemorrhoidal bleeding	If not affecting quality of life, reassure. Consider local treatment of haemorrhoids (diet, topical creams). Consider surgical referral for 3rd degree haemorrhoids.
	Primary inflammatory bowel disease	Send stool culture. If mild or moderate, refer within 2 weeks to a gastroenterologist. If severe, *this is an emergency*—discuss immediately with a gastroenterologist.
	Diverticular bleeding	*This is an emergency* Discuss immediately with a GI surgeon
	Viral infection (eg, CMV)	*This is an emergency* Discuss immediately with a gastroenterologist.
	Newly diagnosed neoplasia second primary/tumour recurrence/advanced polyp	Refer urgently to the appropriate oncology team requesting an appointment within 2 weeks.
	If all tests are negative, but symptoms persist	Consider colonoscopy. Optimise bowel function and stool consistency. Reassure and request GP to check Hb as clinically indicated.

APC, argon plasma coagulation; CMV, cytomegalovirus; GI, gastrointestinal; GP, general practitioner; RBC, red blood cell; RFA, radiofrequency ablation.