Anaemia - normocytic

Who to refer:

• Patients whose anaemia remains unexplained following the recommended primary care investigations or if unresponsive to haematinic replacement
• Anaemia with increased reticulocyte count
• Anaemia where blood film suggests myelodysplasia (MDS)

Who not to refer:

• Anaemia due to haematinic deficiency if responsive to appropriate replacement
• For proven anaemia of chronic disorders (see definition above) – investigate for underlying cause based on patient’s symptoms and clinical findings.

How to refer:

SCI gateway to the Department of Haematology at BGH

Primary care investigations

• Blood film
• U&Es and LFTs
• CRP
• Thyroid function tests
• B12 and folate. Treat if deficiency is detected
• Ferritin. Treat if deficiency is detected and consult separate Anaemia due to iron deficiency GP Referral Guideline for further management
• If ferritin normal check iron and transferrin on a fasting blood sample (take sample in morning with nothing to eat and only water to drink since midnight)
• If serum iron is low and transferrin ≥3.0 g/l on a fasting sample, this is diagnostic of iron deficiency – treat and consult Anaemia due to iron deficiency GP Referral Guideline for further management
• Reticulocyte count.
• Immunoglobulins and serum electrophoresis