Anaemic and symptomatic |
▸ Consider blood transfusion (checking ferritin, transferrin saturation, RBC folate and vitamin B12 before transfusion). ▸ If iron deficient: consider iron supplements and coeliac screen (ie tissue transglutaminase and IgA levels), OGD, SI biopsy, colonoscopy and renal tract evaluation.
|
Anaemic but not symptomatic |
▸ Check ferritin, transferrin saturation, RBC folate and vitamin B12. Replace if necessary, monitor response. If unexplained consider coeliac screen, OGD, SI biopsy and colonoscopy and renal tract evaluation. ▸ If anaemia is unexplained, refer to haematology.
|
Abnormal urea, electrolytes |
▸ Urine dipstix. ▸ Discuss with supervising clinician within 24 hours. ▸ Consider appropriate intravenous fluid therapy/oral replacement. ▸ If K+ <3 mmol/L or >6 mmol/L, this is an emergency. ▸ If Na+ <120 or >150 mmol/L, this is an emergency.
|
Abnormal liver function tests (new onset) |
▸ Discuss with supervising clinician within 24 hours. ▸ Check thyroid function ▸ Patient will need a liver ultrasound and liver screen including hepatitis A, B, C and E serology, EBV and CMV, ferritin, α feta protein, α 1 antitrypsin, coeliac serology, liver autoantibodies, total Igs, cholesterol, triglycerides, caeruloplasmin (<50 years old only).
|
Abnormal liver function tests (long standing) |
|
Abnormal glucose level |
▸ If known diabetic:
|
Abnormal corrected calcium level |
▸ If 2.6–2.9 mmol/L: discuss with supervising clinician within 24 hours. ▸ If <1.8 mmol/L or >3.0 mmol/L: this is an emergency. ▸ Check parathyroid hormone levels.
|