PTU-057 Iron deficiency anaemia referral under the two week rule: is primary care getting it right?

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One of the criteria under the Two Week Referral (TWR) rule for suspected GI malignancy is iron deficiency anaemia (IDA). It is hypothesised that there is a high degree of imprecision in the sensitivity between IDA and other causes of anaemia in primary care. The aim of the present study is to determine the percentage of patients referred under the TWR that were diagnosed correctly with IDA by primary care.


A retrospective observational study was completed on patients referred to St Peter’s Hospital between April and October 2016 under the TWR for suspected gastrointestinal malignancy. CT, OGD, colonoscopy and haematological results were analysed for each patient, alongside referral documentation from the GP.


641 patients were referred, of which 571 were analysed. Of the 571, 14% (80) had been referred by with reported IDA, of which: 32.5% (26/80) were identified as true IDA on haematological analysis; 35.0% (28/80) were anaemias of another underlying cause, and the remaining 32.5% (26/80) showed no signs of anaemia. Of the 80 referrals for IDA, 67.5% (54) were false positives, and there were a further 2.3% (13/571) patients whose IDA was not picked up in the primary care setting.


The present study highlights that despite clear NICE guidelines, there is significant imprecision in the detection and referral of IDA under the TWR. We have identified that of the 571 patients involved, 14% (80) were referred with IDA of which 67.5% (54) were inaccurate referrals. Enforcing objectives to target these faults could go a long way to meeting the Sustainability and Transformation plans to reduce wasteful activity.

Disclosure of Interest

None Declared

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