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.

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.