How should I manage a patient with suspected iron deficiency anaemia, and when should I consider referral to a haematologist?

Manage a patient with suspected iron deficiency anaemia by prescribing an oral iron supplement such as ferrous sulfate, ferrous fumarate, or ferrous gluconate, and continue treatment for 3 months after the deficiency is corrected to replenish iron stores ².

Do not wait for investigations before starting iron therapy, but monitor the response to ensure adequacy ².

Investigate and address any underlying causes that can be managed in primary care, such as menorrhagia or medication use ¹.

If dietary deficiency is suspected, advise a balanced intake of iron-rich foods and consider referral to a dietitian ¹.

Refer to gastroenterology if there are signs of gastrointestinal pathology, such as overt bleeding, or if the patient has persistent anaemia despite treatment, or if they meet criteria for urgent investigation (e.g., age over 50 with marked anaemia or family history of colorectal cancer) ¹.

Consider urgent referral to a haematologist if the patient has profound anaemia with signs of heart failure, develops anaemia again without an obvious cause after treatment, or if the type of anaemia is uncertain and further haematological investigations are needed ¹.