TY - JOUR
T1 - Automatic laboratory-initiated reflex testing to identify patients with autoimmune hemolytic anemia
AU - Froom, Paul
AU - Neck, Alexander
AU - Shir, Michaela
AU - Haavis, Rosa
AU - Barak, Mira
PY - 2005/7
Y1 - 2005/7
N2 - The clinical usefulness of automatic laboratory-initiated testing of patients with recent-onset normocytic anemia to diagnose autoimmune hemolytic anemia (AIHA) is uncertain. During a 28-month period, we performed 784,185 CBC counts. Patients without a history of anemia had reticulocyte count testing if hemoglobin values were less than 10 g/dL (<100 g/L) and mean corpuscular volume was 80 μm3 (80 fL) or more. A direct antiglobulin test (DAT) was performed if the uncorrected reticulocyte count was 2% or more of the RBCs (≥0.02). Of 784,185 CBC counts, 3,841 (0.49%) revealed recent-onset normocytic anemia, 424 (11.04%) with reticulocyte counts of 2% (0.02) or more. Of those with elevated reticulocytes counts, 52 (12.3%) had positive DAT results. Patient information was available for 40 patients. Physicians were unaware of the existence of AIHA in 33 (83%) of them. Of the 40 patients, 11 (28%) were treated with steroids and 6 (15%) were hospitalized; in 2 patients (5%), medications were stopped because they were suspected to have caused the hemolytic anemia. Automatic laboratory testing for patients with recent-onset normocytic anemia ensures recommended practices, probably saves physician visits, and, for some patients, results in more timely diagnosis and appropriate treatment.
AB - The clinical usefulness of automatic laboratory-initiated testing of patients with recent-onset normocytic anemia to diagnose autoimmune hemolytic anemia (AIHA) is uncertain. During a 28-month period, we performed 784,185 CBC counts. Patients without a history of anemia had reticulocyte count testing if hemoglobin values were less than 10 g/dL (<100 g/L) and mean corpuscular volume was 80 μm3 (80 fL) or more. A direct antiglobulin test (DAT) was performed if the uncorrected reticulocyte count was 2% or more of the RBCs (≥0.02). Of 784,185 CBC counts, 3,841 (0.49%) revealed recent-onset normocytic anemia, 424 (11.04%) with reticulocyte counts of 2% (0.02) or more. Of those with elevated reticulocytes counts, 52 (12.3%) had positive DAT results. Patient information was available for 40 patients. Physicians were unaware of the existence of AIHA in 33 (83%) of them. Of the 40 patients, 11 (28%) were treated with steroids and 6 (15%) were hospitalized; in 2 patients (5%), medications were stopped because they were suspected to have caused the hemolytic anemia. Automatic laboratory testing for patients with recent-onset normocytic anemia ensures recommended practices, probably saves physician visits, and, for some patients, results in more timely diagnosis and appropriate treatment.
KW - Anemia
KW - Laboratory
KW - Normocytic
KW - Workup
UR - http://www.scopus.com/inward/record.url?scp=21744457234&partnerID=8YFLogxK
U2 - 10.1309/CFEECW31UYLHUJQG
DO - 10.1309/CFEECW31UYLHUJQG
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AN - SCOPUS:21744457234
SN - 0002-9173
VL - 124
SP - 129
EP - 132
JO - American Journal of Clinical Pathology
JF - American Journal of Clinical Pathology
IS - 1
ER -