History, Examination and Urine dip
Fast-track as below if appropriate
Admit if severe symptomatic anaemia
Comprehensive medical history to include:
  • Ethnicity (thalassaemia)
  • Diet + lifestyle (weight loss, vegetarian/vegan, alcohol intake)
  • Gastrointestinal symptoms (malabsorption/dyspepsia/melaena)
  • Medications
  • Female patient: Obstetric/gynaecologic
  • Significant comorbidity (renal/inflammatory)
Clinical examination to include:
  • Reticuloendothelial
  • Gastrointestinal
  • Signs of hypothyroidism
  • Urine Dip
Signs and Symptoms – SEE NICE GUIDANCE FOR OTHER SCENARIOS Action NICE 2015 link
ANAEMIA (iron-deficiency)
+ 60 and over 2ww referral [1.3.1]Colorectal
(unexplained) with rectal bleeding in adults under 50 Consider 2ww referral [1.3.3]Colorectal
without rectal bleeding, adults under 60 Offer testing with quantitative FIT [1.3.4]Colorectal
ANAEMIA (non-iron-deficiency)
without rectal bleeding, 60 and over Offer testing with quantitative FIT [1.3.4]Colorectal
Haemoglobin levels low
+ visible haematuria in women 55 and over Consider a direct access USS [1.5.12]Endometrial
+ upper abdominal pain, 55 and over Consider non-urgent direct access upper gastrointestinal endoscopy [1.2.3]Oesophageal
[1.2.9]Stomach

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