Iron deficiency anemia referral checklist

Urgency tier

• Hemodynamic instability or syncope.
• Hemoglobin less than 80 g/L or rapidly dropping hemoglobin.
• Melena, hematemesis, or significant GI bleeding.
• New dysphagia, weight loss, or systemic symptoms.
• Pregnancy with symptomatic anemia.

Minimum pre-referral workup

• CBC with indices and reticulocyte count if available.
• Ferritin and iron studies (transferrin saturation).
• B12 and folate if macrocytosis or mixed picture.
• Review for bleeding sources and medication contributors (NSAIDs, anticoagulants).
• Consider celiac serology if iron deficiency is unexplained.

Referral packet checklist

• Duration of anemia and symptoms (fatigue, dyspnea, pica).
• Menstrual history, GI symptoms, and bleeding risk factors.
• Complete lab trend summary with ferritin and iron indices.
• Response to oral iron or intolerance.
• Relevant comorbidities and current medications.

Pre-referral optimization tasks

• Start or continue iron replacement when appropriate and tolerated.
• Investigate and mitigate active bleeding sources manageable in primary care.
• Reinforce urgent return precautions for syncope, chest pain, or ongoing significant bleeding.

References

• BC Guidelines Iron Deficiency (opens in a new tab)

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