Chronic anaemia

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.

    • Haemolytic anaemia
    • Any evidence of pancytopenia (Hb <100g/L, Neutrophils <1.0, PLT <50)
    • Abnormal blood film (circulating blasts, leucoerythroblastic or dysplastic changes)
    • New unexplained back pain along with features of myeloma
    • Hypercalcaemia
    • Cancer in a child or young person is uncommon but must be addressed as a matter of urgency. Advice should be sought from an on-call specialist and/or emergency department when a diagnosis of cancer is strongly suspected.
    • Refer to local 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).
    • 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.

  • 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
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.

  • 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
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

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)

3. Additional referral information Useful for processing the referral

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

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: 28 September 2026

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