Ahmad Maud, Chin-Yee Benjamin, Chin-Yee Ian H, Hedley Ben, Hsia Cyrus C
Schulich School of Medicine and Dentistry, London, Ontario, Canada.
Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
PLOS Digit Health. 2024 Aug 21;3(8):e0000580. doi: 10.1371/journal.pdig.0000580. eCollection 2024 Aug.
This retrospective cross-sectional study investigates the impact of laboratory-specific hemoglobin reference intervals on electronic consultation (eConsult) referral patterns for suspected anemia and elevated hemoglobin at a tertiary care center in London, Ontario that serves Southwestern Ontario. The study analyzed referrals through the Ontario Telemedicine Network's eConsult platform for hemoglobin abnormalities, excluding patients under 18 years old, between July 1, 2019, and June 30, 2023.The main outcome measures were influence of hemoglobin reference intervals on the referral patterns for suspected anemia and elevated hemoglobin, as well as the extent of pre-referral laboratory testing. Of the 619 eConsults reviewed, 251 referrals for suspected anemia and 93 for elevated hemoglobin were analyzed. Referral patterns showed significant variance in hemoglobin levels based on different laboratory thresholds. Referrals for suspected anemia in females from laboratories whose lower limit was 120 g/L or greater had a hemoglobin concentration 7.5 g/L greater than referrals that used laboratories with a threshold lower than 120 g/L. The study also identified potential areas for improvement in pre-referral investigations; 44% of eConsults did not provide a ferritin level, 53% were missing a B12 level, and 81% were missing a reticulocyte count. In conclusion, laboratory reference intervals for hemoglobin significantly influence referral patterns for suspected hemoglobin abnormalities in Ontario's eConsult system. There is a need for standardized reference intervals and comprehensive pre-referral testing to avoid unnecessary medicalization and referrals. We propose an anemia management algorithm to guide primary care providers in the pre-referral investigation process.
这项回顾性横断面研究调查了特定实验室血红蛋白参考区间对安大略省伦敦市一家为安大略省西南部服务的三级医疗中心疑似贫血和血红蛋白升高的电子会诊（eConsult）转诊模式的影响。该研究分析了2019年7月1日至2023年6月30日期间通过安大略远程医疗网络的eConsult平台转诊的血红蛋白异常患者，不包括18岁以下的患者。主要结局指标是血红蛋白参考区间对疑似贫血和血红蛋白升高转诊模式的影响，以及转诊前实验室检测的程度。在审查的619次eConsult中，分析了251例疑似贫血转诊和93例血红蛋白升高转诊。转诊模式显示，基于不同的实验室阈值，血红蛋白水平存在显著差异。下限为120g/L或更高的实验室转诊的女性疑似贫血患者的血红蛋白浓度比使用阈值低于120g/L实验室的转诊患者高7.5g/L。该研究还确定了转诊前调查中潜在的改进领域；44%的eConsult未提供铁蛋白水平，53%缺少维生素B12水平，81%缺少网织红细胞计数。总之,血红蛋白的实验室参考区间显著影响安大略省eConsult系统中疑似血红蛋白异常的转诊模式。需要标准化的参考区间和全面的转诊前检测，以避免不必要的医疗化和转诊。我们提出了一种贫血管理算法，以指导初级保健提供者进行转诊前调查。
