Direct to an emergency department for:
- Shortness of breath or chest pain, syncope or pre-syncope with iron deficiency (ferritin below the lower limit of normal).
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.
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.