Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
When considering referring a patient with anaemia of chronic disease to a specialist for further evaluation, particularly if chronic kidney disease (CKD) is a contributing factor, consider the following:
- If the estimated glomerular filtration rate (eGFR) is above 60 ml/min/1.73 m², other causes of anaemia should be investigated, as it is unlikely to be caused by CKD NICE NG203.
- If the eGFR is between 30 and 60 ml/min/1.73 m², other causes of anaemia should be investigated, with the extent of investigation guided by clinical judgement, as the anaemia may be caused by CKD NICE NG203.
- If the eGFR is below 30 ml/min/1.73 m², while anaemia is often caused by CKD, other causes should still be considered NICE NG203.
General considerations for referral for further evaluation of anaemia, which may apply to anaemia of chronic disease, include:
- When the type of anaemia is in doubt NICE CKS,NICE CKS.
- When further haematological investigations are required that cannot be carried out in primary care, such as bone marrow examination or an investigation of a bleeding state NICE CKS,NICE CKS.
- For people aged 60 years and over with non-iron-deficiency anaemia, offer quantitative faecal immunochemical testing for colorectal cancer NICE NG12.
- For people aged 55 years and over with low haemoglobin levels and upper abdominal pain, consider a non-urgent, direct access upper gastrointestinal endoscopy for oesophageal or stomach cancer NICE NG12.