Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
Am J Hematol. 2012 Jun;87(6):634-6. doi: 10.1002/ajh.23172. Epub 2012 Mar 31.
Little is known about referrals from primary care providers (PCPs) for suspected hematologic malignancies, including their clinical triggers and frequency. A random sample of 190 Massachusetts PCPs were presented with a vignette concerning a patient with a new finding of moderate anemia, asked how they would respond, and then asked what they would do if the patient returned with persistent anemia plus one additional sign or symptom. We also asked about referral behaviors for suspected hematologic malignancies during the prior year. A total of 134 (70.5%) PCPs responded. At first anemia presentation,only 3.8% reported referring to hematology. The development of a second sign or symptom yielded higher referral rates: pancytopenia 588.7%, leukopenia 5 63.9%, thrombocytopenia 5 63.9%, lymphadenopathy 5 42.9%, leukocytosis 5 37.6%, night sweats 5 25.6%, and weight loss 5 23.3%. The median yearly number (interquartile range) of patients PCPs reported suspecting of having hematologic malignancy was 5 (3, 10), and the median formally referred was 5 (3, 10). We conclude that anemia plus signs and symptoms suggestive of myelodysplasia or leukemia (compared with those suggestive of lymphoma) are more likely to prompt hematology referral. In addition, given their rarity,the numbe
关于初级保健医生（PCP）对疑似血液系统恶性肿瘤的转诊，知之甚少，包括其临床触发因素和频率。我们随机抽取了 190 名马萨诸塞州的 PCP，向他们展示了一个有关新发现中度贫血患者的案例，询问他们的反应，然后询问如果患者持续贫血并出现另一个体征或症状，他们会怎么做。我们还询问了他们在过去一年中对疑似血液系统恶性肿瘤的转诊行为。共有 134 名（70.5%）PCP 做出了回应。在首次出现贫血时，只有 3.8%的人报告转诊血液科。出现第二个体征或症状会导致更高的转诊率：全血细胞减少症 588.7%，白细胞减少症 563.9%，血小板减少症 563.9%，淋巴结病 542.9%，白细胞增多症 537.6%，盗汗 525.6%和体重减轻 523.3%。PCP 报告怀疑患有血液系统恶性肿瘤的患者的年中位数（四分位距）为 5（3，10），中位数正式转诊为 5（3，10）。我们得出结论，贫血加上提示骨髓增生异常或白血病的体征和症状（与提示淋巴瘤的体征和症状相比）更有可能促使血液科转诊。此外，鉴于其稀有性，
