Severe iron deficiency anaemia caused by bed bug parasitisation without a rash

Iron deficiency anaemia may develop in elderly patients, particularly those with decreased activities of daily living or social isolation, if their living environment is chronically infested by bed bugs.Bed bug bites do not always present skin symptoms, as repeated exposure may lead to desensitization and an attenuated cutaneous reaction, especially in older adults.Careful history-taking and a thorough physical examination, including inspection of the patient's clothing and living environment, are essential to determine if bed bugs are the cause of otherwise unexplainable anaemia.