Laboratory anemia investigation: a question and answer approach for physicians in primary care.
Inga Zelvyte, MD, Tamara Zafirova MD, Marie-Louise Lennartsson, DC
Clinical Chemistry Laboratory, CountyHospital, Jönköping, Sweden.
E-mail: inga.zelvyte @lj.se
Introduction. Anemia in primary health care is a common and complex problem because it is often a symptom of an underlying disease. There are different customs for requesting laboratory tests used to verify and differentiate anemia at primary health care units in JönköpingCounty, in Sweden.
Aim. We aimed to improve the utilisation of clinical chemistry laboratory at primary health care units by creating a flow chart for the laboratory diagnosis of anemia. Special consideration was given to exclude or verifyiron, folate or cobalamin deficiency-related anemia.
Methods and study design. The constructed flow chart has started with a redesign of commonly used request protocol. We have made an insert for physician with four questions regarding patient’s clinical history. The answers entered into the request protocol determine the selection of laboratory tests in the algorithm for the diagnosis of anemia.
Results. Forty seven clinically suspected anemia cases from three primary care units (Öxnehaga, Mullsjö and Gränna) were forwarded to the laboratory of Clinical Chemistry, County Hospital Ryhov for anemia evaluation.
We have found thirty one cases with haemoglobin concentration below the lower limit of reference interval. We have then followed the other steps of the algorithm for those cases. The deficiency of iron, folate or cobalamin deficiency was verified or excluded in twenty six cases. In addition, we have clarified other reasons for remaining five cases of anemia. Each investigation took from one to seven days (median 3.5 days) to perform. Moreover, the individual interpretative comment for each case was introduced for the first time.
Conclusion. Our results suggest that the application of the flow chart for the diagnosis of anemia may improve utilisation of laboratory service. Our flow chart for the laboratory investigation of anemia contains a simple algorithm and facilitates the diagnosis of frequently occurring anemias. However, laboratory diagnosis obtained with the help of this algorithm should always be reviewed in the context of clinical history of every individual case.
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