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Updated by: Dr. Julie Panepinto and Dr. Paul Scott
Updated on: 5/9/2017


Signs and symptoms

  • Pallor
  • Fatigue (acute or chronic)
  • Onset of jaundice
  • Headache
  • Associated illness
  • Diet
  • Family history Diagnosis
  • Important to compare values ( hemoglobin, indices) obtained on local testing with normal childhood values as there are significant differences between adult and childhood norms
  • Newborn hemoglobin typically 17 to 19 g
  • 8 to 12 weeks of age is the physiologic nadir with normal values 9 to 11 g, lower in premature infants
  • Gradual rise to hemoglobin 11.5 - 13.5 by about a year of age
  • Adult values reached by ages 13 to 15


  • Dietary deficiency, especially iron
  • Chronic hemolytic anemia, for example, sickle cell disease
  • Acute onset of hemolytic anemia, for example, autoimmune hemolytic anemia
  • Acute fall in hemoglobin due to blood loss

Referring provider's initial evaluation and management:

Diagnosis and Treatment Physical exam and therapy:

  • History
  • Vital signs
  • Pallor
  • Fatigue
  • Jaundice
  • Altered mental status
  • CBC
  • Indices
  • Reticuloyte count

When to initiate referral/ consider refer to Hematology Clinic:


  • Hemoglobin less than 6 to 7 g/dL
  • Rapidly falling hemoglobin
  • New onset of jaundice
  • Headache/altered state of consciousness

To be seen in two weeks:

Mild to moderate anemia especially of recent onset where there is no history of dietary insufficiency

What can referring provider send to Hematology Clinic?

1. Using Epic

  • Please complete the external referral order

In order to help triage our patients and maximize the visit, the following information would be helpful include with your referral order:

  • Urgency of the referral
  • What is the key question you would like answered?

Note: Our office will call to schedule the appointment with the patient.

2. Not using Epic external referral order:

  • In order to help triage our patients maximize the visit time, please fax the above information to (414) 607-5288
  • It would also be helpful to include:
  • Chief complaint, onset, frequency
  • Recent progress notes
  • Labs and imaging results
  • Other Diagnoses
  • Office notes with medications tried/failed in the past and any lab work that may have been obtained regarding this patient's problems.

Specialist's workup will likely include:

After referral to Hematology Clinic:

  • CBC
  • Reticulocyte count
  • Smear
  • Chemistries
  • Coombs test
  • Possibly iron studies
  • Vitamin levels
  • Bone marrow evaluation

After examination:

  • Recommendations for local therapy and local follow-up CBC to evaluate response