North South North West Statewide

Pre-referral work-up


Causes of anaemia are varied.  Appropriate features on history, examination and blood film comments may suggest an underlying cause. 

All referrals should comply to referral standards and include in particular:

  • Relevant investigations, including previous results to assess temporal pattern.


Full Blood Examination

  • Microcytic anaemia
    • Iron studies (Iron deficiency – see note above)
    • Haemoglobin electrophoresis (thalassaemia/haemoglobinopathy
  • Normocytic anaemia
    • The most common causes are chronic renal failure (reduced synthesis of erythropoietin) and anaemia of chronic disease. Clinical features are critical in the assessment.
  • Macrocytic anaemia
    • Dedicated blood film assessment looking for dysplastic features
    • Liver function tests (Liver disease)
    • Thyroid function tests (hypothyroidism)
    • Haemolysis screen (reticulocytosis due to haemolysis can cause macrocytosis)

Bilirubin, haptoglobin (reduced), lactate dehydrogenase (LDH), direct agglutination test (DAT), Reticulocytes.

Interim/GP management

To refer a patient with this condition, please see the Haematology clinic page for the full referral process and templates.

Iron deficiency anaemia with a history of gastrointestinal blood loss should be referred to Gastroenterology or GI Surgery for consideration of endoscopy.

For more information please see the Tasmanian Health Pathways website.


Severe cytopenias if patient is unwell (i.e. infection, symptomatic anaemia, active bleeding):

  • Neutrophils < 0.5 x 10^9/L
  • Haemoglobin < 80g/L
  • Platelets <20 x 10^9/L

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.


Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 8302  Fax: (03) 6777 5201
MCH ED – Phone: 0409 867 492  Fax: (03) 6441 5923
NWRH ED – Phone: 0459 848 725  Fax: (03) 6464 1926
RHH ED - Phone: (03) 6166 6101  Fax: (03) 6173 0489 - Discuss with the on call Haematologist/Registrar via switch (03) 6166 8308


Urgent Referrals generally need to be seen in the next one to two weeks

Please discuss these with the Haematology Registrar/Haematologist on call via switchboard on 6166 8308


Triaged by medical staff and generally seen in the next six to eight weeks


Triaged by medical staff and given the next available appointment