Anaemia/Iron deficiency

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Haemodynamic instability or significant bleeding attributed to a gastrointestinal (GI) source
    • Severe anaemia (Hb <70 g/L) with risk of cardiovascular compromise or syncope
    • Anaemia with overt GI bleeding (e.g. haematemesis, melena)
    • Severe cytopenias in an unwell patient (e.g. infection, symptomatic anaemia, or active bleeding):
      • ­    Neutrophils <0.5 × 10⁹/L
      • ­    Haemoglobin <70 g/L
      • ­    Platelets <20 × 10⁹/L
    • Pancytopenia (Hb <100 g/L, Neutrophils <1.0 × 10⁹/L, Platelets <50 × 10⁹/L)
    • Haemolytic anaemia
    • Abnormal blood film (circulating blasts, leucoerythroblastic or dysplastic changes)
    • New unexplained back pain with features suggestive of myeloma
    • Hypercalcemia

    Rapid Access Clinics (RACs)

    Rapid Access Clinics (RACs) provide timely specialist assessment for patients with non-emergency but urgent conditions, helping avoid unnecessary emergency department presentations. Patients must be clinically stable and suitable for outpatient management. Common referrals include acute flares of chronic conditions, abnormal test results, and mild infections. Referrals are made by calling the on-call service to confirm eligibility and availability.

    • Features suggestive of malignancy or significant structural disease, including:
      • Progressive dysphagia or odynophagia with inability to tolerate oral intake
      • Persistent vomiting with dehydration, electrolyte disturbance, or concern for obstruction
      • Palpable abdominal mass or lymphadenopathy with systemic symptoms or rapid
      • Progression
      • Unexplained weight loss (>5% over 6 months) with acute functional decline or clinical deterioration

  • Request for Advice (RFA)

    GPs may use the Request for Advice (RFA) pathway when patients present with mild, stable anaemia or iron deficiency that does not meet criteria for urgent referral. This allows specialist input while supporting ongoing management in primary care and avoiding unnecessary waitlisting.

    • Guidance on further investigations or interpretation of borderline or conflicting results (e.g. isolated low Hb >100 g/L with normal iron studies, B12, folate, and FBC)
    • Advice on ongoing monitoring intervals and thresholds for escalation or referral
    • Recommendations for trial and duration of oral supplementation (iron, vitamin B12, folate) and strategies for intolerance
    • Clarification on the need for gastrointestinal or haematological investigations where the patient has no alarm features or prior investigations were normal
    • Management of anaemia in patients with co-morbid chronic conditions (e.g. CKD, diabetes, inflammatory disease)
    • Advice on the appropriateness of parenteral supplementation versus continuing oral therapy in primary care
    • Advice on when specialist review is warranted for isolated, stable low Hb with no clear cause

    Other Useful Information

    • Refer to 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).

    Gastroenterology

    • Consider referral to a dietitian experienced in gastrointestinal disorders where malabsorption, coeliac disease, or dietary intolerance is suspected.
    • Refer to the Iron Deficiency CPC (Gastroenterology) for specific referral criteria.
    • If appropriate, repeat endoscopic evaluation should be based on clinical judgement (see note below).

    Haematology

    • 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
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.

General Medicine referral pathway

  • Refer to General Medicine when anaemia is mild to moderate or when the underlying cause is unclear or multifactorial
  • Symptomatic anaemia (Hb<80g/L) without high risk features or suspicion of hematologic disease
  • Anaemia associated with symptoms such as weight loss, fever, night sweats, or bone pain, where malignancy is suspected but the underlying source is not yet defined.
  • There are multiple comorbidities complicating iron deficiency management.
  • The cause is unclear and does not meet the criteria for Gastroenterology or Haematology referral.

Haematology referral pathway

  • 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

Gastroenterology referral pathway

  • Refer to Gastroenterology when iron deficiency or anaemia suggests a gastrointestinal source regardless of iFOBT/FIT results.
  • Iron deficiency, defined as ferritin and/or transferrin saturation below the laboratory reference range, with any of the following concerning features:
    • Anaemia persisting despite correction of other potential causative factors.
    • Unexplained symptoms suggestive of malignancy, including unintentional weight loss.
    • Abnormal imaging of the gastrointestinal tract.
    • Palpable mass on abdominal or rectal examination.
    • New iron deficiency with no alternative explanation in any patient (alternative explanations include but are not limited to diet low in iron, haematuria, or menstruation)
  • Anaemia with new overt gastrointestinal bleeding which is sufficient to explain and correlated with the anaemia but has only occurred for a limited time where iron deficiency may not yet have developed, should be referred to gastroenterology.

Note: iFOBT/FIT results may identify patients at risk but cannot exclude gastrointestinal pathology. A negative iFOBT/FIT should not delay referral in patients with iron deficiency anaemia.

Note: Patients with positive iFOBT/FIT but normal iron studies should be considered under the appropriate screening pathway (e.g., bowel cancer screening program) rather than automatic GI referral.

Note:Referrals for anaemia/iron deficiency should be directed through the most clinically appropriate pathway. This may include a complementary care pathway, a Dietitian First gastroenterology clinic pathway.  The triage process should be guided by the patient’s predominant clinical features, the suspected underlying cause, and the investigations or interventions most likely to be required.

In some Hospital and Health Services (HHSs), patients may be considered for an initial assessment by a Dietitian, either before or instead of being referred to Gastroenterology. This approach supports appropriate and timely referrals to the most suitable pathway, ensuring patients receive the care that best addresses their specific needs.
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.

General Medicine referral pathway

  • Refer to General Medicine when anaemia is mild to moderate or when the underlying cause is unclear or multifactorial
  • Persistent unexplained mild to moderate anaemia (Hb 80-110g/L)
  • Anaemia refractory to iron or B12 or folate supplementation
  • Anaemia associated with chronic disease or multiple comorbidities requiring coordinated management

Haematology referral pathway

  • 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

Gastroenterology referral pathway

  • Refer to Gastroenterology when iron deficiency or anaemia suggests a gastrointestinal source.
  • Iron deficiency with or without anaemia that does not meet Category 1 criteria, including:
    • Longstanding (>2 years), unchanged iron deficiency without anaemia, including in menstruating patients.
    • Explained iron deficiency without anaemia in any patient where there is clinical suspicion of a secondary contributing gastrointestinal cause

Note:Referrals for anaemia/iron deficiency should be directed through the most clinically appropriate pathway. This may include a complementary care pathway, a Dietitian First gastroenterology clinic pathway.  The triage process should be guided by the patient’s predominant clinical features, the suspected underlying cause, and the investigations or interventions most likely to be required.

In some Hospital and Health Services (HHSs), patients may be considered for an initial assessment by a Dietitian, either before or instead of being referred to Gastroenterology. This approach supports appropriate and timely referrals to the most suitable pathway, ensuring patients receive the care that best addresses their specific needs.
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.

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • Details of relevant signs and symptoms.
  • Details of all treatments offered and their efficacy.
  • Relevant medical history and comorbidities.
  • Supplementation history, including dose and duration of oral or parenteral iron, vitamin B12, and/or folate.
  • Duration of anaemia (if known).
  • Medication history, including prescription, over-the-counter (OTC), and complementary medicines (particularly NSAIDs, aspirin, corticosteroids, immunosuppressants, antiplatelets, and anticoagulants).
  • Baseline investigations:
    • Full Blood Count (FBC)
    • Electrolytes and Liver Function Tests (E/LFTs)
    • Erythrocyte Sedimentation Rate (ESR)
    • Thyroid Stimulating Hormone (TSH)
    • Iron studies (serum iron, ferritin, transferrin saturation)

Haematology specific

  • 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)

Gastroenterology specific

  • Include when referring for suspected gastrointestinal causes of anaemia or iron deficiency:
  • Family history of gastrointestinal malignancy or hereditary syndromes (e.g. FAP, Lynch syndrome)
  • Menstrual history (particularly in premenopausal women)
  • Dietary iron intake and relevant nutritional history
  • Coeliac disease serology results
  • Details of previous gastrointestinal investigations (e.g. endoscopy, colonoscopy, imaging)
  • Type and duration of iron replacement therapy
  • History of NSAID or aspirin use

3. Additional referral information Useful for processing the referral

  • Symptomatic anaemia (Hb < 80 g/L) with no high-risk features
  • History of alcohol or drug use
  • History of menorrhagia
  • Serum soluble transferrin receptor assay (if available)
  • Gastroenterology specific

Haematology specific

  • Haemolysis screen (only if reticulocyte count is high)
  • 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 or oral iron therapy
  • C-reactive protein (CRP), if not already performed

Gastroenterology specific

  • Urine MCS results

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    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
    • 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
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    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

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    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.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 29 September 2026

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