Anaemia Protocol- Copyright. All rights reserved. 

PRACTICE  "ANAEMIA MANAGEMENT"  PROTOCOL  

30.03.20 Dr M.Nazrul HOSSAIN; updated from 2012 Protocol. 

For context – discussing with my past colleagues “Anaemia management” has been a recurring    problem for the past 30 years as a cause of complaints.

This section includes ideas for good record keeping about Anaemia. 

To protect ourselves legally it is sensible to have a high standard.  

For adults : Hb < 100g /litre à Needs urgent referral to GI or Haematology or Gynaecology; as appropriate.

Hb <80g /litre à Discuss with colleagues ; and the Medical on call team at hospital urgently on the same day for possible Hospital Admission. Record the name of the colleague or hospital doctor in your computer  notes. 

If Platelets are very low – discuss with the hospital on-call team. The patient may need a platelet infusion.

Ask about bleeding from body sites (GI/ GU/ RS) and record this in your EMIS notes. 

STOP ASPIRIN/ CLOPIDOGREL/ APIXABAN / DIPYRIDAMOLE that might cause GI bleeding; and record this in your EMIS  notes. 

Arrange further blood tests to check ESR, B12, Folate & Ferritin; and record this in your EMIS  notes.  

If the patient is haemodynamically stable with normal BP, Pulse, Oxygen Saturation and NEWS SCORE then the hospital Medical team may not want to    admit the patient; sometimes because of a shortage of beds or blood products or Covid / Influenza Virus risk  in hospitals . This was a big problem in Marc  2020 when Covid-19 hit the UK. 

This was the advice that I was given in 2012 but the Anaemia clinics have been set up in the past 10 years.

One of the Concerns   is that the patient with very low Hb often collapses and goes to A+E  two to three   months later. 

Refer as 2WW referral anyway for Hb < 80g/ litre to GI or Haematology; and ask for advice from colleagues here and  the hospital on-call Medical team; and record this in your EMIS  notes. 

The hospital Triage system for referrals is poor – done non clinical secretary; so it is up to us as GPs to flag this as URGENT and put this referral in an URGENT or 2WW CATEGORY to protect us legally; and record this in your EMIS  notes.