›Oral iron as outpatient when stable and cause addressed local protocol dependent
›IV iron consideration when malabsorption or intolerance local protocol dependent
Diagnostic sequencing
›Underproduction workup when indicated
›Reticulocyte count interpretation branch
›Smear review for blasts
›Consider marrow evaluation if pancytopenia or blasts
›Blood loss workup when indicated
›Identify overt bleeding source
›Imaging or endoscopy pathway per stability and local protocol dependent
Reassessment loop
›Timed reassessment
›Repeat vitals every 15 to 30 minutes if moderate to severe symptoms
›Repeat symptom check after each unit transfused
›Repeat exam for new bleeding
›Disposition changing findings
›New chest pain
›New hypoxia
›Persistent tachycardia despite transfusion and fluids
17Disposition/dispo23
Level of care criteria
›ICU or resuscitation level care
›Ongoing hemodynamic instability
›Massive transfusion requirement
›Active myocardial ischemia with instability
›Severe respiratory distress or hypoxia
›Inpatient admission
›Suspected GI bleed requiring inpatient endoscopy
›Hemolysis requiring urgent treatment
›Symptomatic anemia requiring transfusion and monitoring
›New pancytopenia or blasts
›Observation pathway
›Stable vitals after limited transfusion
›Etiology evaluation pending but low immediate risk
Discharge criteria
›Clinical stability
›Stable vitals without orthostatic symptoms
›No ongoing bleeding
›Symptoms improved to baseline function
›Diagnostic clarity and follow up
›Etiology plan established
›Follow up arranged within 72 hours to 2 weeks based on severity
›Reliability
›Able to return if worse
›Access to medications and labs
18Discharge Instructions/di21
Copy discharge instructions
›Summary
›You were seen for symptoms related to low blood count called anemia
›Your testing today did not show signs of life threatening instability at this time
›Medications
›Take iron only if prescribed
›Avoid NSAIDs unless your clinician says it is safe
›Activity
›Avoid heavy exertion until cleared
›Rise slowly from sitting or lying to reduce dizziness
›Follow up
›Follow up with your primary care clinician within the recommended timeframe
›Complete repeat blood work as arranged
›Additional testing may be needed to find the cause of anemia
›Return to emergency department now if
›Fainting
›Chest pain
›Trouble breathing at rest
›Black stools or red blood in stools
›Vomiting blood
›Heavy vaginal bleeding
›New severe weakness or confusion
19References/r17
Guidelines and key sources
›RBC transfusion thresholds and strategy
›AABB clinical practice guideline for red blood cell transfusion 2016
›Restrictive transfusion strategy evidence summary and limitations
›Iron deficiency anemia evaluation
›British Society of Gastroenterology guideline on iron deficiency anemia in adults 2021
›GI malignancy evaluation considerations
›Upper GI bleeding management
›American College of Gastroenterology guideline for upper GI and ulcer bleeding 2021
›Risk stratification tool context
›Hemolysis and autoimmune hemolytic anemia
›British Society for Haematology guideline on autoimmune hemolytic anemia 2017
›Escalation triggers for thrombotic microangiopathy
›WHO anemia definitions
›World Health Organization hemoglobin thresholds 2011
›Population level definitions and limitations for acute care
›Project instructions source file
›Formatting and structure requirements
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
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