Clinical Pathology Consultation Improves Coagulation Factor Utilization in Hospitalized Adults

Abstract

Coagulation factor replacement can effectively treat or prevent most hemophilia complications, but it is expensive. Although published data describe how to achieve therapeutic goals through cost-effective selection and dosing of replacement products, criteria are not universally known or followed. A review of our institution's experience revealed overdosing of coagulation factors in the majority of patients treated during a 12-month period, at a cost that approached $700,000. Consequently, we established mandatory clinical pathology consultation before releasing such factors. In the subsequent 30 months, 32 adults received 64 courses of treatment. For patients with hemophilia A, the mean cost per admission was reduced by approximately 27% (total savings, $61,536). For patients with factor VIII inhibitor, there was an approximate 6% cost reduction (total savings, $47,292). The combined savings was $108,828. The mean plasma factor level achieved during the intervention period was 84% +/- 55% compared with 117% +/- 58% for the preintervention period (P = .008). Neither the number of treatment (factor transfusion) days nor the number of RBC transfusions changed significantly. Our data support that pathology consultation yields consistent and appropriate therapy and improves resource utilization.

Algorithmic Approach With Clinical Pathology Consultation Improves Access to Specialty Care for Patients With Systemic Lupus Erythematosus

“…For example, pathology consultation for coagulation factor replacement for patients with hemophilia in a tertiary care center resulted in appropriate therapy and significant financial savings. 18 Blood bank monitoring of blood components and intervention when suboptimal transfusion practice was identified resulted in improved survival and decreased transfusion need in the postoperative period of massively transfused patients. 19 Tormey and Smith 20 review additional potential models by which clinical pathologists can integrate consultation into daily practice.…”

The transfusion medicine specialist as a coagulation consultant: a new variant of therapeutic pathology

“…Based on the demonstrated need for better coagulation consultation for improved patient care, especially around the use of transfusion interventions, and the importance of having a detailed appreciation of the laboratory evaluation of hemostasis to make therapeutic decisions, we believe that the transfusion community should embrace an expanded role for at least some transfusion specialists that combines transfusion and hemostasis expertise. We also note that there are undoubtedly a number of individuals who already have the appropriate training and/or experience, some of whom are already active in such roles . It is difficult to assess how many such individuals this could represent, but it is interesting to observe what additional training transfusion experts may already have, at least as documented by board certification.…”

“…In addition to consultative practice in the areas noted, there are also previously described examples of blood bankers providing expanded consultation at the interface of laboratory coagulation and transfusion. For instance, several studies have shown that consultation on coagulation factor and blood product dosing by transfusion medicine specialists has led to reduced product wastage and better clinical outcomes versus historical controls . In addition to improving patient care and providing for a more efficacious utilization of health care resources, expanded clinical consultation has the potential to raise the visibility of a hospital's transfusion service…”

Educating Medical Students in Laboratory Medicine

“…Evidence shows that such services improve patient care and outcomes. [55][56][57] Indeed, this is an area of as a starting point for medical schools to design curriculum content and evaluation techniques. We also hope that this report will inspire dialogue among primary care and specialist nonpathologist physicians as to the proper degree of education in this area.…”