Iron Deficiency Anaemia (IDA)

This condition is treated in the Gastroenterology clinic.

Pre-referral work-up

History

All referrals should comply to the referral standards and include in particular:

• Family history of gastrointestinal cancer
• Menstrual history
• Dietary iron history

Tests

Pathology:

• LFT
• FBC
• U&E
• Iron studies
• Coeliac disease serology results (only for pre-menopausal and Paed pts)

Imaging:

Any relevant

Investigations:

Nil

Interim/GP management

To refer a patient with this condition, please see the Gastroenterology clinic page for the full referral process and templates.

Recommended pre-referral treatment

Lifestyle Changes: If dietary, modify diet and/or refer to dietician.

Medical Management:  Establish and treat the cause e.g. Menorrhagia, dietary.

Treatment with oral iron prior to referral:

• Preparations with elemental iron 80mg-325mg per tab are absorbed better if taken with vitamin C 50mg
• Take one tablet daily of iron + vitamin C and in the presence of anaemia continue for 3 months after haemoglobin has been corrected to replenish stores

Treat constipation and warn of iron effects on stool.

For more information please see the HealthPathways Tasmania website.

Gastroenterological Society of Australia resources:

• Iron Deficiency Guideline (2015)
• Patient Information about Iron Deficiency

Clinic appointments

? Red location flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency

?Potentially life threatening symptoms suggestive of:

• acute upper GI tract bleeding
• acute severe lower GI tract bleeding
• oesophageal foreign bodies/food bolus
• bowel obstruction
• abdominal sepsis
• Acute Severe Colitis - see note

? Severe vomiting and/or diarrhoea with dehydration
? Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services
? Biliary sepsis (to be referred to a centre with ERCP service)

Note -Acute severe colitis as defined by the Truelove and Witts criteria - all patients with greater than or equal to 6 bloody bowel motions per 24 hours plus at least one of the following:

• temperature at presentation of over 37.8°C,
• pulse rate at presentation of over 90 bpm,
• haemoglobin at presentation of under 105 gm/l, CRP over 30mg/dl at presentation (or ESR over 30 mm/hr)

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Urgent (Category 1)

Iron deficiency anaemia (IDA) or iron deficiency (below the lower limit of the laboratory reference) with any of the following concerning features “ select any that apply:

• no obvious cause
• persisting despite correction of potential causative factors
• weight loss greater than or equal to5% of body weight in previous 6 months
• mass palpable on abdominal or rectal examination
• positive faecal occult blood test (iFOBT) if asymptomatic

We will endeavour to see these patients within four weeks

Urgent referrals should be accompanied by a phone call to the clinic and the relevant doctor for urgent assessment, or patient should be directed immediately to the Emergency Department.

Semi-urgent (Category 2)

Iron deficiency without any concerning features (as above).

Availability

North

Launceston General Hospital
Level 3 - Specialist Clinics

Phone: 1300 977 694
Fax: 03 6777 5227

North West

All North West referrals are managed via  Mersey Community Hospital
Phone: 03 6478 5222
Fax: 03 6441 5942

South

Wellington Clinics (Level 10)
Phone: 03 6166 0000
Fax: 03 6234 3982