Elevated Iron Studies

Emergency

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
Useful Management Information

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)

If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • Ferritin level >1000ug/L +/- elevated transferrin saturation and/or presence of Red flags

    Presence of Red flags
  • 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 Red flags

Category 3
(appointment within 365 calendar days)
  • Normal ferritin with positive HFE gene study

If your patient does not meet the minimum referral criteria

  • Consider other treatment pathways or an alternative diagnosis
  • If you still need to refer your patient:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service
Standard Referral Information

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g. tracheostomy in place, oxygen required)
  • 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 functioning – low/medium/high
  • 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.)

Essential referral information

Without this information the referral will be returned

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

Out of catchment

West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.

Feedback

To provide feedback about contents on this website or general referral questions please email WM-CPC@health.qld.gov.au or phone 3413 7402.