학술논문
Diagnostic Workup of Microcytic Anemia: An Evaluation of Underuse or Misuse of Laboratory Testing in a Hospital Setting Using the AlinIQ System.
Document Type
Academic Journal
Author
Cadamuro J; From the Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (Cadamuro, Haschke-Becher, Keppel, Oberkofler, Felder, Mrazek).; Simundic AM; The Department of Medical Laboratory Diagnostics, Faculty of Pharmacy and Biochemistry, University Hospital Sveti Duh, University of Zagreb, Zagreb, Croatia (Simundic).; von Meyer A; The Institute for Laboratory Medicine and Medical Microbiology, München Clinic, Munich, Germany (von Meyer).; Haschke-Becher E; From the Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (Cadamuro, Haschke-Becher, Keppel, Oberkofler, Felder, Mrazek).; Keppel MH; From the Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (Cadamuro, Haschke-Becher, Keppel, Oberkofler, Felder, Mrazek).; Oberkofler H; From the Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (Cadamuro, Haschke-Becher, Keppel, Oberkofler, Felder, Mrazek).; Felder TK; From the Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (Cadamuro, Haschke-Becher, Keppel, Oberkofler, Felder, Mrazek).; Mrazek C; From the Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (Cadamuro, Haschke-Becher, Keppel, Oberkofler, Felder, Mrazek).
Source
Publisher: College of American Pathologists Country of Publication: United States NLM ID: 7607091 Publication Model: Print Cited Medium: Internet ISSN: 1543-2165 (Electronic) Linking ISSN: 00039985 NLM ISO Abbreviation: Arch Pathol Lab Med Subsets: MEDLINE
Subject
Language
English
Abstract
Context.—: Underuse of laboratory testing has been previously investigated in preselected populations, such as documented malpractice claims. However, these numbers might not reflect real-life situations.
Objective.—: To evaluate the underuse and misuse of laboratory follow-up testing in a real-life hospital patient population with microcytic anemia, using laboratory results ordered during routine patient care.
Design.—: From all patients in whom a microcytic anemia was detected during routine diagnostics in 2018, all available laboratory data were collected and screened for appropriateness of diagnostic workup of iron deficiency and thalassemia. Subgroup analysis was performed for patient groups with mean corpuscular volume values 75 to 79 μm3 (group 1), 65 to 74 μm3 (group 2), and <65 μm3 (group 3).
Results.—: A total of 2244 patients with microcytic anemia were identified. Follow-up testing for iron deficiency was not performed in 761 cases (34%). For inconclusive ferritin levels due to elevated C-reactive protein results (n = 336), reticulocyte hemoglobin content or soluble transferrin receptor levels were missing in 86 cases (26%). In patients with suspected thalassemia (n = 127), follow-up testing for hemoglobin variants was not performed in 70 cases (55%). Subgroup analysis showed that the frequency of underuse of iron status as well as thalassemia/hemoglobinopathy testing decreased from group 1 to group 3. When considering relevant preexisting anemia diagnoses, laboratory tests were underused in 904 cases (40.3%).
Conclusions.—: Because 40% (n = 904) of the patients with microcytic anemia were potentially not followed up correctly, laboratory specialists are advised to act by implementing demand management strategies in collaboration with clinicians to overcome underuse of laboratory tests and to improve patient safety.
(© 2023 College of American Pathologists.)
Objective.—: To evaluate the underuse and misuse of laboratory follow-up testing in a real-life hospital patient population with microcytic anemia, using laboratory results ordered during routine patient care.
Design.—: From all patients in whom a microcytic anemia was detected during routine diagnostics in 2018, all available laboratory data were collected and screened for appropriateness of diagnostic workup of iron deficiency and thalassemia. Subgroup analysis was performed for patient groups with mean corpuscular volume values 75 to 79 μm3 (group 1), 65 to 74 μm3 (group 2), and <65 μm3 (group 3).
Results.—: A total of 2244 patients with microcytic anemia were identified. Follow-up testing for iron deficiency was not performed in 761 cases (34%). For inconclusive ferritin levels due to elevated C-reactive protein results (n = 336), reticulocyte hemoglobin content or soluble transferrin receptor levels were missing in 86 cases (26%). In patients with suspected thalassemia (n = 127), follow-up testing for hemoglobin variants was not performed in 70 cases (55%). Subgroup analysis showed that the frequency of underuse of iron status as well as thalassemia/hemoglobinopathy testing decreased from group 1 to group 3. When considering relevant preexisting anemia diagnoses, laboratory tests were underused in 904 cases (40.3%).
Conclusions.—: Because 40% (n = 904) of the patients with microcytic anemia were potentially not followed up correctly, laboratory specialists are advised to act by implementing demand management strategies in collaboration with clinicians to overcome underuse of laboratory tests and to improve patient safety.
(© 2023 College of American Pathologists.)