Chronic Anaemia
Adult

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Emergency Referrals

Useful Management Information

Refer to local HealthPathways for assessment and management recommendations.
Address and treat any underlying or contributing causes (e.g. heavy menstrual loss, poor nutrition, chronic disease).
If a dietary cause is suspected, modify diet and/or refer to a dietitian.
Trial oral supplementation (e.g. iron, vitamin B12, folate) for at least three months before determining treatment failure.
Cease or review aggravating medications where possible (e.g. NSAIDs, aspirin, corticosteroids).
Trial of appropriate oral supplementation should be completed before referral, unless contraindicated or not tolerated.
Consider non-gastrointestinal causes of anaemia (e.g. haemolysis, marrow disorders) prior to referral.
Repeat Investigations: If a patient has been fully investigated within the past two years, both the referrer and receiving clinician should exercise clinical discretion regarding the need and value of repeating endoscopy or colonoscopy

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Referrals for anaemia or iron deficiency may be directed to General Medicine, Haematology, or Gastroenterology, depending on the clinical presentation and suspected underlying cause. Referrals will be triaged to the specialty most appropriate to the dominant clinical features and anticipated diagnostic or therapeutic requirements: General Medicine for patients with multisystem comorbidity, complex medical presentations, or where anaemia is part of a broader medical condition requiring comprehensive assessment. Haematology for suspected primary haematological disorders, unexplained cytopenias, abnormal blood indices, or anaemia refractory to initial management. Gastroenterology for patients with suspected or confirmed gastrointestinal blood loss, iron deficiency suggestive of gastrointestinal pathology, or where endoscopic investigation is anticipated. Where there is diagnostic uncertainty, referrals may be accepted by the most clinically appropriate service and redirected following initial assessment to ensure timely access to definitive care. Refer to Haematology when anaemia suggests a primary hematologic cause or requires specialist input due to severity Hb level of < 80g/L regardless of cause Hb level of 80-100g/L with severe symptoms, such as dyspnoea, chest pain, syncope, or hemodynamic instability Anaemia of any degree where there is a diagnosis or strong suspicion of haemolytic anaemia
Category 2 (appointment within 90 calendar days)	Referrals for anaemia or iron deficiency may be directed to General Medicine, Haematology, or Gastroenterology, depending on the clinical presentation and suspected underlying cause. Referrals will be triaged to the specialty most appropriate to the dominant clinical features and anticipated diagnostic or therapeutic requirements: General Medicine for patients with multisystem comorbidity, complex medical presentations, or where anaemia is part of a broader medical condition requiring comprehensive assessment. Haematology for suspected primary haematological disorders, unexplained cytopenia’s, abnormal blood indices, or anaemia refractory to initial management. Gastroenterology for patients with suspected or confirmed gastrointestinal blood loss, iron deficiency suggestive of gastrointestinal pathology, or where endoscopic investigation is anticipated. Where there is diagnostic uncertainty, referrals may be accepted by the most clinically appropriate service and redirected following initial assessment to ensure timely access to definitive care. Refer to Haematology when anaemia suggests a primary hematologic cause or requires specialist input due to severity Haemoglobin (Hb) 80–100 g/L without an identifiable or treatable cause Suspected or confirmed haemolytic anaemia Complex anaemia requiring specialist diagnostic evaluation or parenteral iron therapy not managed by General Medicine
Category 3 (appointment within 365 calendar days)	Referrals for anaemia or iron deficiency may be directed to General Medicine, Haematology, or Gastroenterology, depending on the clinical presentation and suspected underlying cause. Referrals will be triaged to the specialty most appropriate to the dominant clinical features and anticipated diagnostic or therapeutic requirements: General Medicine for patients with multisystem comorbidity, complex medical presentations, or where anaemia is part of a broader medical condition requiring comprehensive assessment. Haematology for suspected primary haematological disorders, unexplained cytopenia’s, abnormal blood indices, or anaemia refractory to initial management. Gastroenterology for patients with suspected or confirmed gastrointestinal blood loss, iron deficiency suggestive of gastrointestinal pathology, or where endoscopic investigation is anticipated. Where there is diagnostic uncertainty, referrals may be accepted by the most clinically appropriate service and redirected following initial assessment to ensure timely access to definitive care. Haematology referral pathway Isolated low Hb >100 g/L without an identifiable or treatable cause Note: Patients with mild, stable anaemia and no concerning features may be appropriately managed in General Medicine or primary care, depending on local service arrangements.
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

Include when referring for suspected haematological causes or unexplained anaemia:

Serial FBC results and reticulocyte counts
Iron studies, vitamin B12, and folate levels (if indicated)
TFTs, E/LFTs, including LDH
Serum protein electrophoresis and serum free light chain assays
Coombs test (if haemolysis suspected)

Evidence that non-haematological causes have been excluded, such as:

Faecal occult blood (FOB) x3 or iFOBT/FIT
Coeliac screen
Gynaecological history (menstrual or postmenopausal bleeding)
Midstream urine (MSU) for microscopy, culture, and sensitivity (M/C/S)

Additional Referral Information

Haemolysis screen (only if there is a high reticulocyte count)
Serum protein electrophoresis and serum free light chain assay
Haemoglobin electrophoresis (if MCV <80 and iron studies are normal)
Coombs test or haptoglobin (if haemolysis suspected)
Intrinsic factor antibody results (if vitamin B12 deficiency suspected)
Coagulation profile
Transfusion requirements
Presence of co-morbid chronic disease
Prior B12, oral iron therapy
C-reactive protein (CRP), if not already performed

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Haematology qhRefer

Fax

(07) 5687 4497

Post

Cancer Referrals Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

(07) 5687 2708

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Rachel Wooldridge

Medical Director Haematology

Facilities

Gold Coast University Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Chronic AnaemiaAdult