Birgens H, Christensen B E, Hansen N E, Jensen M K, Junker K, Jørgensen F S, Nielsen J L, Nissen N I
Medicinsk haematologisk afdeling C, Københavns Amts Sygehus i Gentofte, Hellerup.
Ugeskr Laeger. 1991 Jun 3;153(23):1638-47.
The malignant haematological disorders comprise the main groups leukemia, malignant lymphoma and multiple myeloma and the potentially malignant disorders: myelodysplastic syndrome, polycythaemia vera, myelofibrosis and M-component of uncertain significance. The common feature of all these disorders is monoclonality, i.e. they originate from one single cell. Around 2,000 new cases are diagnosed per year in Denmark. Because of the relative small number of patients, complex diagnosis and treatment (especially the possibility of cure on intensive treatment) a high degree of centralization is warranted to secure an evenly distributed high level of patient care and research. The present rules for referral of patients are unsatisfactory. A new referral system is proposed based on a common set of rules, agreed upon by five haematological centers in Denmark and the surrounding region, comprising diagnostic procedures, treatment, research and development for all haematological patients in the area. Based on these common rules (functional centralization) it is decided whether the individual patient can be treated in the primary hospital or should be referred to a center (geographical centralization). Recommendations about diagnosis, treatment and referral are made in this report. Detailed suggestions are given for diseases which may be treated locally whereas no detailed regimens are given for diseases and disease stages which should be centralized. In the latter cases, the main emphasis is placed on a presentation of treatment results.
恶性血液系统疾病主要包括白血病、恶性淋巴瘤和多发性骨髓瘤等组群，以及潜在恶性疾病：骨髓增生异常综合征、真性红细胞增多症、骨髓纤维化和意义未明的M成分。所有这些疾病的共同特征是单克隆性，即它们都起源于单个细胞。丹麦每年约有2000例新病例被诊断出来。由于患者数量相对较少、诊断和治疗复杂（特别是强化治疗有可能治愈），因此有必要进行高度集中化，以确保患者护理和研究水平的均匀分布。目前的患者转诊规则并不令人满意。基于丹麦及其周边地区的五个血液学中心商定的一套共同规则，提出了一种新的转诊系统，该系统包括该地区所有血液学患者的诊断程序、治疗、研究和开发。根据这些共同规则（功能集中化），决定个体患者是可以在基层医院接受治疗还是应转诊至中心（地理集中化）。本报告提出了关于诊断、治疗和转诊的建议。对于可以在当地治疗的疾病给出了详细建议，而对于应集中治疗的疾病和疾病阶段则没有给出详细方案。在后一种情况下，主要重点是呈现治疗结果。
