Anaemia

Check ferritin
- (beware falsely normal ferritin as also inflammatory marker)
- If low – confirmed iron deficiency anaemia
  - Consider 2ww lower GI
    - Unexplained anaemia in men or non-menstruating women
    - FH – colorectal cancer in first degree relatives
  - History: Heavy periods, diet, urine dip, stool parasites
  - Investigate: Coeliacs serology (TTG)
  - Treat: Ferrous fumarate OD and increase as tolerated to BD + consider laxative – recheck Hb/Ferritin in 3 months
- If normal/raised – consider anaemia of chronic disease or ferritin acting as acute phase reactant (in which case check serum iron/TIBC)
  - raised serum iron/TIBC and reduced transferrin saturation indicates iron deficiency
consider Hb electrophoresis
- Beta Thalassaemia trait – raised HbA2
- Alpha Thalassaemia trait – difficult diagnosis as no specific test
  - If confirmed, discuss with haematology as appropriate

Consider
- anaemia of chronic disease – chronic inflammation, endocrine, CKD, liver disease, malnutrition, MDS, haemochromatosis
- mixed haematinic deficiency
- recent blood loss
- investigate as per raised MCV

History: bleeding, diet, medications, alcohol, FHx, recent transfusion
Investigate: U+Es, LFTs+GGT, TFTs, B12, Folate, Blood film, Reticulocytes
Consider myeloma screen: serum/urine electrophoresis, immunoglobulins, bone profile
Refer to haematology if
- abnormal cell shapes on blood film
- persistent unexplained anaemia, raised MCV or B12 deficiency
- spherocytes on blood film -> DAT + reticulocytes -> refer if raised

Abnormalities affecting more than one cell type (Hb, WCC, platelets) are more likely due to bone marrow causes. Consider early referral if the patient is unwell
Urgent referral to haematology
- Leucoerythroblastic anaemia on blood film
- Unexplained progressive symptomatic anaemia
- Associated splenomegaly/lymphadenopathy or other cytopenias