Specialty: Gastroenterology
Age group: Adult
Direct to an emergency department for:
- Shortness of breath or chest pain, syncope or pre-syncope with iron deficiency (ferritin below the lower limit of normal).
Criteria for referral to public hospital specialist clinic services
- Persistent iron deficiency in men and post-menopausal women with either:
- ferritin less than 30 micrograms per litre
- ferritin 30-100 micrograms per litre in the presence of inflammation (e.g. C-reactive protein (CRP) greater than or equal to 5 milligrams per litre)
- Iron deficiency that persists despite correction of potential causative factors
- Iron deficiency in pre-menopausal women:
- with positive coeliac serology
- with positive faecal occult blood test
- that persists despite treatment of menorrhagia, with good cycle control.
Information to be included in the referral
Information that must be provided
- History of menorrhagia
- Dietary history, including red meat intake
- Iron studies or serum ferritin
- Full blood examination
- Coeliac serology results
- Current and complete medication history (including non-prescription medicines, herbs and supplements).
Provide if available
- Faecal occult blood test
- Faecal calprotectin
- Any family history of gastrointestinal cancer.
Additional comments
The Summary and referral information lists the information that should be included in a referral request.
Referrals for iron deficiency related to persistent, heavy menstrual bleeding should be made to suitable community-based services wherever possible (see 1800 My Options). Where this is not practicable, referrals should be directed to a gynaecology service provided by the health service. For more information see Persistent heavy menstrual bleeding.
Where appropriate and available, the referral may be directed to an alternative specialist clinic or service.
Referral to a public hospital is not appropriate for
- Iron deficiency in pre-menopausal women with:
- no positive coeliac serology
- negative faecal occult blood test
- managed menorrhagia and with good cycle control
- Isolated low serum iron
- Non-iron deficiency anaemia without evidence of blood loss
- Vegetarian diet without iron supplementation.
Reviewed 30 May 2025