HNY Policy and Pathway Repository - North Yorkshire

Anaemia with normal MCV

None provided

Consider

• Anaemia of chronic disease - most common cause 
• Renal anaemia (eGFR < 45) 
• Acute blood loss
• Haemolysis
• Haematinia deficiency
• Haematological causes - e.g. MDS, myeloma

Check

• Assess for bleeding clinically
• Vit B12, folate, ferritin
• Reticulocyte count, LDH
• U&E, LFT
• Blood film if not already available
• Consider myeloma screen (serum protein electrophoreisis and urine BJP) if other causes excluded. Not a first line investigation. 

Urgent referral to Haematology

• Elevated reticulocyte count
  • Consider bleeding or haemolysis - assess for bleeding clinically and review LDH and BIL. Haemolusis suggested if raised BIL/LDH
• If haemolysis then urgent referral to Haematology
• If bleeding - refer as appropriate (e.g. to gastro, urology e.c.t) 

Refer to renal team if:

• Significant CKD - renal team to manage renal anaemia

See paraprotein guidance if:

• Positive myeloma screen
  • Checked calcium
  • Evaluated for bone pain

Haematinic deficiency

• Replace as appropriate

Consider A&G if:

• Investigations negative / no significant abnormality
• Suspect anaemia of chronic disease if co-morbidities present. Optimise management chronic disease(s).
• Consider A&G if no comorbidities / cause not clear

 

• Harrogate and District