The effectiveness of a routine versus an extensive laboratory analysis in the diagnosis of anaemia in general practice

Schop, Annemarie; Kip, Michelle M.A.; Stouten, Karlijn; Dekker, Soraya; Riedl, Jürgen; Houten, Ron J. van; Rosmalen, Joost van; Dinant, Geert Jan; IJzerman, Maarten J.; Koffijberg, Hendrik; Bindels, Patrick J E; Kusters, Ron; Levin, Mark‐David

doi:10.1177/0004563217748680

Cited by 12 publications

(21 citation statements)

References 14 publications

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“…This study has been retrospectively conducted in a cohort of patients formed by general practitioners (GPs) participating in a large project on anaemia evaluation improvement 8. Therefore, the patients’ involvement has been limited.…”

Section: Methodsmentioning

confidence: 99%

Long-term outcomes in patients newly diagnosed with iron deficiency anaemia in general practice: a retrospective cohort study

et al. 2019

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ObjectivesTo describe all iron deficiency anaemia (IDA)–related causes during follow-up of patients newly diagnosed with IDA and to assess whether a delayed colorectal cancer (CRC) diagnosis influences survival.Design and settingRetrospective cohort study of patients from general practices in the Dordrecht area, the Netherlands.ParticipantsMen and women aged ≥50 years with a new diagnosis of IDA (ie, no anaemia 2 years previously).MethodFrom February 2007 to February 2018, all relevant data were collected from the files of the referral hospital. Early IDA-related cause was defined as established within 18 weeks after IDA diagnosis. Cox proportional-hazards regression was used to analyse survival of patients with CRC diagnosis.Results587 patients with IDA were included with a median follow-up of 4.6 years. Early and late IDA-related causes could be established in 32% and 8% of patients, respectively. Early and late CRC was found in 8% and 2% of patients, respectively, and were located mainly right sided. After adjustment for age, gender and TNM classification, mortality risk was lower in patients with IDA with early CRC diagnosis, but not significantly (HR 0.30, 95% CI 0.09 to 1.02).ConclusionEven with extended follow-up, the cause of IDA remains elusive in the majority of patients with IDA in general practice. However, patients with IDA are at increased risk for in particular right-sided CRC and a late diagnosis of CRC appears to have a detrimental effect on survival in patients with IDA.

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Section: Methodsmentioning

confidence: 99%

Long-term outcomes in patients newly diagnosed with iron deficiency anaemia in general practice: a retrospective cohort study

et al. 2019

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“…In one study, the use of a limited laboratory analysis was compared to a more extensive laboratory analysis. They found that an extensive laboratory analysis leads more often to establishment of the anemia etiology [7]. Moreover, extensive laboratory analysis would prevent a delay in the initiation of treatment for the underlying disease and has shown to be cost-effective [8].…”

Section: Introductionmentioning

confidence: 99%

A new diagnostic work-up for defining anemia etiologies: a cohort study in patients ≥ 50 years in general practices

et al. 2020

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Background: To study etiologies of anemia using an extensive laboratory analysis in general practices. Method: An extensive laboratory analysis was performed in blood of newly diagnosed anemia patients aged ≥50 years from the general population in the city of Dordrecht area, the Netherlands. Eight laboratory-orientated etiologies of anemia were defined. Patients were assigned one or more of these etiologies on the basis of their test results. Results: Blood of 4152 patients (median age 75 years; 49% male) was analyzed. The anemia etiology was unclear in 20%; a single etiology was established in 59%; and multiple etiologies in 22% of the patients. The most common etiologies were anemia of chronic disease (ACD) (54.5%), iron deficiency anemia (IDA) (19.1%) and renal anemia (13.8%). The most common single etiologies were IDA (82%) and ACD (68%), while the multiple etiologies most commonly included folic acid deficiency (94%) and suspected bone marrow disease (88%). Older age was associated with a lower incidence of IDA and a higher incidence of renal anemia. Mild anemia was more often associated with ACD and uncertain anemia, while severe anemia was mainly seen in patients with IDA. Conclusion: Extensive laboratory analysis in anemic patients from the general population helped clarify the etiology of anemia and revealed many various combinations of etiologies in a significant proportion of patients. Age, sex and the severity of anemia are predictive of the underlying etiology.

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“…In this section, an explanation of the questionnaire and the database used in this questionnaire will be provided. A more extensive description was published previously [31].…”

Section: Methodsmentioning

confidence: 99%

Preventing overuse of laboratory diagnostics: a case study into diagnosing anaemia in Dutch general practice

Kip

Oonk

Levin

et al. 2020

BMC Med Inform Decis Mak

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Background: More information is often thought to improve medical decision-making, which may lead to test overuse. This study assesses which out of 15 laboratory tests contribute to diagnosing the underlying cause of anaemia by general practitioners (GPs) and determines a potentially more efficient subset of tests for setting the correct diagnosis. Methods: Logistic regression was performed to determine the impact of individual tests on the (correct) diagnosis. The statistically optimal test subset for diagnosing a (correct) underlying cause of anaemia by GPs was determined using data from a previous survey including cases of real-world anaemia patients. Results: Only 9 (60%) of the laboratory tests, and patient age, contributed significantly to the GPs' ability to diagnose an underlying cause of anaemia (CRP, ESR, ferritin, folic acid, haemoglobin, leukocytes, eGFR/MDRD, reticulocytes and serum iron). Diagnosing the correct underlying cause may require just five (33%) tests (CRP, ferritin, folic acid, MCV and transferrin), and patient age. Conclusions: In diagnosing the underlying cause of anaemia a subset of five tests has most added value. The realworld impact of using only this subset should be further investigated. As illustrated in this case study, a statistical approach to assessing the added value of tests may reduce test overuse.

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The effectiveness of a routine versus an extensive laboratory analysis in the diagnosis of anaemia in general practice

Cited by 12 publications

References 14 publications

Long-term outcomes in patients newly diagnosed with iron deficiency anaemia in general practice: a retrospective cohort study

Long-term outcomes in patients newly diagnosed with iron deficiency anaemia in general practice: a retrospective cohort study

A new diagnostic work-up for defining anemia etiologies: a cohort study in patients ≥ 50 years in general practices

Preventing overuse of laboratory diagnostics: a case study into diagnosing anaemia in Dutch general practice

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