When should I consider referring a patient with anaemia of chronic disease to a specialist for further evaluation?

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 ⁵.
• 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 ⁵.
• If the eGFR is below 30 ml/min/1.73 m², while anaemia is often caused by CKD, other causes should still be considered ⁵.

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 ¹,².
• 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 ¹,².
• For people aged 60 years and over with non-iron-deficiency anaemia, offer quantitative faecal immunochemical testing for colorectal cancer ³.
• 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 ³.