Criteria for referral to public hospital specialist clinic services

• Persistent iron deficiency in men and post-menopausal women with either:
  • ferritin < 30 µg/L
  • ferritin 30-100 µg/L in the presence of inflammation (e.g. C-reactive protein (CRP) ≥ 5 mg/L)
• Iron deficiency that persists despite correction of potential causative factors
• Iron deficiency in pre-menopausal women:
  • with positive coeliac serology
  • with positive faecal occult blood test
  • that persists despite treatment of menorrhagia, with good cycle control.

Information to be included in the referral

Information that must be provided

• History of menorrhagia
• Dietary history, including red meat intake
• Iron studies or serum ferritin
• Full blood examination
• Coeliac serology results
• Current and complete medication history (including non-prescription medicines, herbs and supplements).

Provide if available

• Faecal occult blood test
• Faecal calprotectin
• Any family history of gastrointestinal cancer.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Referrals for iron deficiency related to persistent, heavy menstrual bleeding should be made to suitable community-based services wherever possible (see 1800 My Options). Where this is not practicable, referrals should be directed to a gynaecology service provided by the health service.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• Iron deficiency in pre-menopausal women with:
  • no positive coeliac serology
  • negative faecal occult blood test
  • managed menorrhagia and with good cycle control
• Isolated low serum iron
• Non-iron deficiency anaemia without evidence of blood loss
• Vegetarian diet without iron supplementation.