HNY Policy and Pathway Repository - Humber

A condition in which there is an iron deficiency resulting in a deficiency of red cells or  haemoglobin in the blood, causing pallor and weariness.  Many people with iron deficiency anaemia will only have a few signs or symptoms.

The most common symptoms include:
•  Tiredness and lethargy (lack of energy)
•  Shortness of breath
•  Heart palpitations (noticeable heartbeats)
•  A pale complexion

Less common symptoms include:
•  Headache
•  Tinnitus (hearing sounds coming from inside the body, rather than from an outside source)
•   An altered sense of taste
•  Feeling itchy
•  A sore or abnormally smooth tongue
•  Hair loss
•  A desire to eat non-food items, such as ice, paper or clay (a condition known as pica)
•  Difficulty swallowing (dysphagia)
•  Painful ulcers (open sores) on the corners of your mouth
•  Spoon-shaped nails

Do Not Refer

Hgb < 11g/dL for males and < 10g/dL for female refer to Upper or lower GI USC.

Women with abnormal menstrual bleeding consider a referral to Gynaecology.

Elderly person who will not tolerate endoscopy refer to CT Abdomen/pelvis or Virtual CT colonoscopy.

Person with significant IDA and palpable abdominal mass refer to CT Abdomen/pelvis or Virtual CT colonoscopy.

Is this new IDA or known chronic IDA
•  History (GI symptoms, PMH e.g  renal disease , FH of CRC, menorrhagia)
•  Clinical examination
•  Urine dipstick for haematurea
•  Record medications (NSAIDs, anticoagulants, antiplatelets)
•  FBC , Ferritin , B12 , folate , BCP , coeliac , TFTs and CRP
•  Previous referrals to GI services and results.

Treatment for iron deficiency anaemia usually involves taking iron supplements and advising patient to alter their diet to increase iron levels, as well as treating any underlying cause, especially in relatioon to Normocytic anaemia (see Oxford Table IDA and ACD).

Refer to the pathway flow for Iron Deficiency Anaemia investigations and treatment and the General Medicine process.

Refer in line with the General Medicine process.

Routine referral to GI clinic with anaemia.

IDA (mild, no GI symptoms, patient on one of the above medications).

Normal FBC with low ferritin after trials of iron course for one year.

Referrals

Complete the Referral Form (on ARDENS) in full and follow details on how to refer.

IDA Oxford Score Table

General Medicine Anaemia Pathway

Investigation for IDA Flowchart

Treatment for IDA Flowchart