Kolnaar B G, van Wijk M A, Pijnenborg L, Assendelft W J
Nederlands Huisartsen Genootschap, afd. Richtlijnontwikkeling en Wetenschapsbeleid, Postbus 3231, 3502 GE Utrecht.
Ned Tijdschr Geneeskd. 2003 Oct 4;147(40):1956-61.
The Dutch College of General Practitioners' practice guideline concerning anaemia advises the general practitioner to carry out additional laboratory tests in patients with a decreased haemoglobin level (Hb) in order to establish the cause of the anaemia. In specified cases (premenopausal women with excessive vaginal bleeding and in some children with mild anaemia) these tests may initially be omitted. In these cases iron can be prescribed and, if a child has had an infectious disease within the previous month, to wait one month to see if levels return to normal. In older patients with iron-deficiency anaemia subsequent investigations should be performed in order to rule out gastro-intestinal neoplasm, even if the history and physical examination give no indication of this. In an anaemic patient at risk of thalassaemia trait, haemoglobin electrophoresis or chromatography should be performed if there is microcytosis and a serum ferritine level > 15 micrograms/l.