Referral to emergency

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

  • haemoglobin (Hb <80g/L) with symptoms of:
    • angina
    • hypercalcaemia
    • evidence of haemolysis
    • abnormal blood film (circulating blasts, leucoerythroblastic blood picture)

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Inclusions

  • persistent unexplained anaemia (haemoglobin <80g/L) with no cause found and haematinic (iron, B12, folate) deficiency has been ruled out

Exclusions

  • iron deficiency
  • B12 deficiency
  • folate deficiency

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • anaemia (haemoglobin Hb <80g/L) with:
    • neutropenia or thrombocytopenia
    • lymphadenopathy/splenomegaly
    • leucoerythroblastic blood picture on blood film examination
  • unexplained persistent anaemia (Hb <80g/L) without red flags such as circulating blasts, leucoerythroblastic blood picture
  • anaemia of any degree with evidence of haemolytic anaemia

Category 2 (appointment clinically indicated within 90 days)

  • unexplained persistent Hb level of 80-100g/L

Category 3 (appointment clinically indicated within 365 days)

  • unexplained persistent Hb >100g/L

Essential referral information

Completion required before first appointment to ensure patients are ready for care. 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.

  • detailed history
    • duration
    • symptoms
    • bleeding
    • diet history
  • past medical history
  • medication history including prior B12 or oral or intravenous iron therapy
  • known or investigated causes of iron deficiency including bleeding or malabsorption
  • blood results
    • complete blood examination (CBE)
    • blood film examination
    • liver function tests (LFTs)
    • electrolytes, urea, creatinine (EUC)
    • estimated glomerular filtration rate (eGFR)
    • lactate dehydrogenase (LDH)
    • iron studies
    • B12
    • folate
    • c-reactive protein (CRP)
    • reticulocyte count
    • direct antiglobulin test (DAT)
    • haptoglobin
    • serum protein electrophoresis
    • serum free light chains
  • any endoscopy or coloscopy results

Clinical management advice

Anaemia is defined as haemoglobin (Hb) < 135 g/L in an adult male and Hb < 125 g/L in an adult female. Causes of anaemia may be multifactorial including haematinic deficiencies, viral infections for example, parvovirus infection, bleeding disorders, anaemia of chronic disease, bone marrow disorders such as myelodysplasia, aplastic anaemia, multiple myeloma.

Iron deficiency should generally be referred to general medicine, gastroenterology, or gynaecology as appropriate for further investigation. Similarly, uncomplicated B12 / folate deficiency does not require routine referral to haematology (see macrocytosis guideline). See Gastroenterology Iron Deficiency with or without Anaemia - Adult CPC

Simple intravenous (IV) iron infusions often do not require a hospital admission. The following services can administer iron infusions in the community

  • Sefton Park Intermediate Care
  • Metropolitan Referral Unit (MRU)

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient 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

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.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • 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 pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.