1 st opportunity (at referral or listing)

1. Pathway for patients referred for consideration of major elective orthopaedic surgery (hip / knee replacement) 1st opportunity (at referral or listing) Check FBC and review results: If Hb: <120g/L (F) or <130g/L (M) Arrange anaemia investigations:(sequential or batch depending on local arrangements ) FBC, retics, UEC, LFT, B12, folate, ferritin, transferrin saturation, CRP Review Visit 1 Non-iron deficiency anaemia – manage accordingly ** Review Anaemia Investigations Apply anaemia management algorithm Further investigation, referral, optimisation including investigation of underlying cause eg: gastroenterology referral – individualised care ≥ 8 weeks before planned surgery date eg: clinically NON-urgent Iron deficiency anaemia: absolute (ferritin <30) or functional (ferritin 30-100 and transferrin saturation<20%) < 8 weeks before planned surgery date eg: clinically urgent** Review Visit 2 Day case admission for IV iron – Recheck Hb after 2 weeks Trial of oral iron Recheck Hb 4 weeks Anaemia persists despite oral iron Hb normalised with oral iron: continue oral iron until surgery Surgery 2-4 weeks depending on response to iv iron and urgency of surgery (may need repeat dose)** **If anaemia persists or surgery is urgent proceed on case by case basis following discussion with surgeon / anaesthetist GP version 2014