Froom P, Mahameed T, Havis R, Barak M
Central Laboratory of Haifa and Western Galilee, Clalit Health Services, Nesher, Israel.
Clin Chem. 2001 Jan;47(1):63-6.
Urgent clinician notification of low hemoglobin values is a common practice. The effect of such notification for samples obtained during an office visit is uncertain.
We notified the attending physicians in 100 consecutive cases of outpatients with hemoglobin <80 g/L. We reviewed the medical charts of these patients with their personal physicians 1-2 months later. We considered transfusions unnecessary only when given to a clinically stable patient with probable iron deficiency anemia in the absence of chronic diseases that produce the anemia.
Overall, 47 (47%) of the patients were referred to the emergency room (ER), and 31 of the 47 (66%) were transfused. Increasing age and decreasing hemoglobin were associated with increased referral of patients to the ER. Six of 31 transfusions were unnecessary. An emergency transfusion was clearly indicated in only 3 of the 31 patients; the other patients were clinically stable. A modified notification strategy excluding microcytic samples >50 g/L would have detected these three patients. Over the follow-up period, no patient not referred to the ER died from complications of anemia, nor were any patients hospitalized with acute symptoms of low hemoglobin.
In some settings, urgent notification of medical outpatient clinics of patients with hemoglobin <80 g/L may lead to unnecessary ER visits.
临床医生紧急通报低血红蛋白值是一种常见做法。对于门诊就诊时采集的样本，这种通报的效果尚不确定。
我们连续对100例血红蛋白<80 g/L的门诊患者的主治医生进行了通报。1至2个月后，我们与这些患者的私人医生一起查阅了他们的病历。仅当临床稳定的可能缺铁性贫血患者在无导致贫血的慢性疾病时接受输血，我们才认为输血不必要。
总体而言，47例（47%）患者被转诊至急诊室（ER），其中47例中的31例（66%）接受了输血。年龄增加和血红蛋白降低与患者转诊至急诊室的增加有关。31例输血中有6例是不必要的。31例患者中仅3例明确需要紧急输血；其他患者临床稳定。一种排除血红蛋白>50 g/L的小细胞样本的改良通报策略本可发现这3例患者。在随访期间，未转诊至急诊室的患者均未死于贫血并发症，也没有患者因血红蛋白低的急性症状住院。
在某些情况下，向门诊诊所紧急通报血红蛋白<80 g/L的患者可能会导致不必要的急诊就诊。
