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Elevated iron studies

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


Potentially life threatening symptoms suggestive of

  • Acute severe GI bleeding
  • Acute liver failure
  • Sepsis in a patient with cirrhosis
  • Severe encephalopathy in a patient with liver disease

Medical management

  • Consider elevated ferritin in presence of NAFLD or ALD
  • Consider venesection if serum ferritin >1000ug/L or C282Y homozygous haemochromatosis
  • Monitor iron studies annually if serum ferritin normal
  • Screen adult family members if genetically confirmed in index case
  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
  • There is no need to follow a low iron diet, however people may choose to reduce red meat intake (e.g. to 90-120 g/day)
  • Consider cessation of alcohol, hepatotoxic medication, herbal preparations, supplements, NSAIDs and benzodiazepines

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Ferritin level >1000ug/L +/- elevated transferrin saturation and/or presence of concerning features
      • Evidence of liver decompensation i.e. jaundice and/or ascites and/or encephalopathy
  • Category 2
    (appointment within 90 calendar days)
    • Ferritin level > 500ug/L  and <1000ug/L without presence of concerning features
  • Category 3
    (appointment within 365 calendar days)
    • Normal ferritin with positive HFE gene study

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • General referral information
  • Alcohol history
  • ELFT FBC HBV HCV serology Fasting glucose and lipid results
  • Iron studies
  • HFE gene studies
  • Upper abdominal USS reports

3. Additional referral information Useful for processing the referral

  • Family history of liver disease or blood disorders
  • Medication history including non-prescription medications, herbs, supplements
  • Previous liver function tests
  • CRP
  • Height, weight and BMI

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.