Suggested Pre-Referral Evaluation and Management Guidelines
Obtain CBC, platelet count, reticulocyte count; serum iron (Fe) and total iron binding capacity (TIBC), serum ferritin.
If serum Fe/TIBC ratio is < 10% and/or serum ferritin < 12 ug/ml, evaluate patient for GI blood loss (stool blood, upper endoscopy, and colonoscopy) and menstrual history before hematology consultation.
If normal or elevated serum iron and total iron binding capacity and serum ferritin, obtain a hemoglobin electrophoresis and/or consider alpha globin chain analysis which is done as send out to Mayo medical labs to exclude thalassemia traits in African Americans, Asians, Asian Indian populations, before referral to hematology.
Suggested Additional Test/Management Prior to Specialty Visit
If the patient has a GI or gyn reason for blood loss, after treatment for the underlying etiology of blood loss, the patient needs 3 months of oral iron therapy (ferrous sulfate 300 mg po TID X 3 months, ferrous gluconate, or ferrous fumarate formulations) prior to a hematology referral.
If all of the previous is done and the patient remains anemic, schedule a consult with hematology faculty who see benign disorders.