Pathway for patients referred for consideration of major elective orthopaedic surgery (hip / knee replacement)

1st opportunity (at referral or listing)

Review Visit 1

Review Visit 2

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 Anaemia InvestigationsApply anaemia management algorithm

Further investigation, referral, optimisation including investigation of underlying cause eg: gastroenterology referral – individualised care

Non-iron deficiency anaemia – manage

accordingly **

Iron deficiency anaemia: absolute (ferritin <30) or

functional (ferritin 30-100 and transferrin saturation<20%)

< 8 weeks before planned surgery date

eg: clinically urgent**

≥ 8 weeks before planned surgery date

eg: clinically NON-urgent

Day case admission for IV iron – Recheck Hb after 2

weeks

Trial of oral ironRecheck 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)**

GP version 2014

**If anaemia persists or surgery is urgent proceed on case by

case basis following discussion with surgeon / anaesthetist