Primary care and hematology department: referral and management guidelines
Introduction: In 2015, we started working on the Improvement Plan of the Outpatient Clinic at the Hematology Department of our Hospital. We noticed that many of the cases referred from Primary Care to the Hematology Department were inappropriate referrals as they had no hematological pathology. An a...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Ubiquity Press
2019-08-01
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| Series: | International Journal of Integrated Care |
| Subjects: | |
| Online Access: | https://www.ijic.org/articles/5081 |
| _version_ | 1811299981052608512 |
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| author | Alasne Uranga Aguirregomezcorta Izaskun Zeberio Etxetxipia Jose Ramon Furundarena Salsamendi Carmen Gonzalez Gonzalez Nerea Uresandi Iruin Larraitz Arrue Izagirre Hodei Arrizabalaga Fernandez Ana Jesus Gonzalez Zumeta Enrique Contreras Fuente Ana Isabel Diez Ruiz Elena Suquia Zabaleta Andoni Orube Bona Maria Araiz Ramirez |
| author_facet | Alasne Uranga Aguirregomezcorta Izaskun Zeberio Etxetxipia Jose Ramon Furundarena Salsamendi Carmen Gonzalez Gonzalez Nerea Uresandi Iruin Larraitz Arrue Izagirre Hodei Arrizabalaga Fernandez Ana Jesus Gonzalez Zumeta Enrique Contreras Fuente Ana Isabel Diez Ruiz Elena Suquia Zabaleta Andoni Orube Bona Maria Araiz Ramirez |
| author_sort | Alasne Uranga Aguirregomezcorta |
| collection | DOAJ |
| description | Introduction: In 2015, we started working on the Improvement Plan of the Outpatient Clinic at the Hematology Department of our Hospital. We noticed that many of the cases referred from Primary Care to the Hematology Department were inappropriate referrals as they had no hematological pathology. An analytical alteration was the main reason for referring patients from primary care. 60% of the referred patients presented one or more of the following 6 alterations according to their blood test: monoclonal gammopathy, leukocytosis, lymphocytosis, neutropenia, monocytosis and/or thrombocytosis. Method: We set up a workgroup composed of primary care, hematologists and nurses. Together, we elaborated guidelines for the referral of patients presenting any of these 6 analytical alterations. In this document, we suggested a series of studies to be carried out in Primary Care prior to referral, and we indicated whether the follow-up should be carried out in the Primary Care Center or in the Hematology Department. We presented this initial document in Primary Care Centers of Donostialdea public health area and their feedback was added into the final version of the document. Results: In the document, there are indications for each 6 of the analytical alterations mentioned above. As an example, neutropenia is summarized: NEUTROPENIA <1.5x109/L neutrophils (neu). To consider: Procedure: -Repeat blood count in 2-3 weeks -Laboratory generates a blood smear if Neu <1x109/L and previous >1x109/L -Analyze: autoimmune disorders (ANA, RF, PCR), vitamin B12 and folic, Igs, HIV. Dismiss:Viral infections, sepsis, drugs (metamizole, antipsychotics, omeprazole, and assess to withdraw it), autoimmune disorders, B12 and folate severe deficiency, aplastic anemia, or bone marrow infiltration. Neu<1.5x109/L is usual in patientsfrom Africa, Caribbean and Middle East: "Benign Ethnic Neutropenia (BEN)" Management in Primary Care: Criteria: -Asymptomatic patient. -Without other cytopenias. -Neu>1x109/L (Caucasian) or Neu>0.5x 109/L in BEN. Procedure:Annual analytical control. Referral (NPC: Non presential consultation): Clinical Criteria(If any of the following): -Recurrent infections -Adenopathy, splenomegaly -B symptoms -Febrile neutropenia* Analytical Criteria (if any): -Neu <1x109/L (Caucasian) or Neu <0.5x109/L (if African, Caribbean or Middle East origin) -Associated cytopenias: anemia, thrombocytopenia. -Blood smear suggests a hemopathy: patient will be given an appointment from the laboratory filter. *If fever and Neu <1x109/L: must be referred to Emergency. Conclusions: The aim of this guideline is to avoid the unnecessary referral of patients who are unlikely to benefit from a specialist opinion. The collaboration between Primary Care and Hematology department allowed us to elaborate an agreed document. We would like this document to be dynamic and we will modify and update it with every suggestion that emerges in response to its use. It is an ongoing co-operation work between Primary Care and Hematology, putting patient´s wellness first. |
| first_indexed | 2024-04-13T06:43:38Z |
| format | Article |
| id | doaj.art-30ad3dc717a8481a908430dcaef12f32 |
| institution | Directory Open Access Journal |
| issn | 1568-4156 |
| language | English |
| last_indexed | 2024-04-13T06:43:38Z |
| publishDate | 2019-08-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | International Journal of Integrated Care |
| spelling | doaj.art-30ad3dc717a8481a908430dcaef12f322022-12-22T02:57:39ZengUbiquity PressInternational Journal of Integrated Care1568-41562019-08-0119410.5334/ijic.s33304448Primary care and hematology department: referral and management guidelinesAlasne Uranga Aguirregomezcorta0Izaskun Zeberio Etxetxipia1Jose Ramon Furundarena Salsamendi2Carmen Gonzalez Gonzalez3Nerea Uresandi Iruin4Larraitz Arrue Izagirre5Hodei Arrizabalaga Fernandez6Ana Jesus Gonzalez Zumeta7Enrique Contreras Fuente8Ana Isabel Diez Ruiz9Elena Suquia Zabaleta10Andoni Orube Bona11Maria Araiz Ramirez12Servicio de Hematología y Hemoterapia - Hospital Universitario Donostia; Instituto Donostia de Onco-Hematología (IDOH)Servicio de Hematología y Hemoterapia - Hospital Universitario Donostia; Instituto Donostia de Onco-Hematología (IDOH)Servicio de Hematología y Hemoterapia - Hospital Universitario Donostia; Instituto Donostia de Onco-Hematología (IDOH)Servicio de Hematología y Hemoterapia - Hospital Universitario Donostia; Instituto Donostia de Onco-Hematología (IDOH)Servicio de Hematología y Hemoterapia - Hospital Universitario Donostia; Instituto Donostia de Onco-Hematología (IDOH)Atención Primaria - ESI DonostialdeaServicio de Hematología y Hemoterapia - Hospital de MendaroAtención Primaria - ESI TolosaldeaAtención Primaria - ESI DonostialdeaAtención Primaria - ESI DonostialdeaInstituto Donostia de Onco-Hematología (IDOH); Servicio de Calidad - Hospital Universitario DonostiaInstituto Donostia de Onco-Hematología (IDOH)Servicio de Hematología y Hemoterapia - Hospital Universitario Donostia; Instituto Donostia de Onco-Hematología (IDOH)Introduction: In 2015, we started working on the Improvement Plan of the Outpatient Clinic at the Hematology Department of our Hospital. We noticed that many of the cases referred from Primary Care to the Hematology Department were inappropriate referrals as they had no hematological pathology. An analytical alteration was the main reason for referring patients from primary care. 60% of the referred patients presented one or more of the following 6 alterations according to their blood test: monoclonal gammopathy, leukocytosis, lymphocytosis, neutropenia, monocytosis and/or thrombocytosis. Method: We set up a workgroup composed of primary care, hematologists and nurses. Together, we elaborated guidelines for the referral of patients presenting any of these 6 analytical alterations. In this document, we suggested a series of studies to be carried out in Primary Care prior to referral, and we indicated whether the follow-up should be carried out in the Primary Care Center or in the Hematology Department. We presented this initial document in Primary Care Centers of Donostialdea public health area and their feedback was added into the final version of the document. Results: In the document, there are indications for each 6 of the analytical alterations mentioned above. As an example, neutropenia is summarized: NEUTROPENIA <1.5x109/L neutrophils (neu). To consider: Procedure: -Repeat blood count in 2-3 weeks -Laboratory generates a blood smear if Neu <1x109/L and previous >1x109/L -Analyze: autoimmune disorders (ANA, RF, PCR), vitamin B12 and folic, Igs, HIV. Dismiss:Viral infections, sepsis, drugs (metamizole, antipsychotics, omeprazole, and assess to withdraw it), autoimmune disorders, B12 and folate severe deficiency, aplastic anemia, or bone marrow infiltration. Neu<1.5x109/L is usual in patientsfrom Africa, Caribbean and Middle East: "Benign Ethnic Neutropenia (BEN)" Management in Primary Care: Criteria: -Asymptomatic patient. -Without other cytopenias. -Neu>1x109/L (Caucasian) or Neu>0.5x 109/L in BEN. Procedure:Annual analytical control. Referral (NPC: Non presential consultation): Clinical Criteria(If any of the following): -Recurrent infections -Adenopathy, splenomegaly -B symptoms -Febrile neutropenia* Analytical Criteria (if any): -Neu <1x109/L (Caucasian) or Neu <0.5x109/L (if African, Caribbean or Middle East origin) -Associated cytopenias: anemia, thrombocytopenia. -Blood smear suggests a hemopathy: patient will be given an appointment from the laboratory filter. *If fever and Neu <1x109/L: must be referred to Emergency. Conclusions: The aim of this guideline is to avoid the unnecessary referral of patients who are unlikely to benefit from a specialist opinion. The collaboration between Primary Care and Hematology department allowed us to elaborate an agreed document. We would like this document to be dynamic and we will modify and update it with every suggestion that emerges in response to its use. It is an ongoing co-operation work between Primary Care and Hematology, putting patient´s wellness first.https://www.ijic.org/articles/5081monoclonal gammopathyleukocytosislymphocytosisneutropeniamonocytosisthrombocytosis |
| spellingShingle | Alasne Uranga Aguirregomezcorta Izaskun Zeberio Etxetxipia Jose Ramon Furundarena Salsamendi Carmen Gonzalez Gonzalez Nerea Uresandi Iruin Larraitz Arrue Izagirre Hodei Arrizabalaga Fernandez Ana Jesus Gonzalez Zumeta Enrique Contreras Fuente Ana Isabel Diez Ruiz Elena Suquia Zabaleta Andoni Orube Bona Maria Araiz Ramirez Primary care and hematology department: referral and management guidelines International Journal of Integrated Care monoclonal gammopathy leukocytosis lymphocytosis neutropenia monocytosis thrombocytosis |
| title | Primary care and hematology department: referral and management guidelines |
| title_full | Primary care and hematology department: referral and management guidelines |
| title_fullStr | Primary care and hematology department: referral and management guidelines |
| title_full_unstemmed | Primary care and hematology department: referral and management guidelines |
| title_short | Primary care and hematology department: referral and management guidelines |
| title_sort | primary care and hematology department referral and management guidelines |
| topic | monoclonal gammopathy leukocytosis lymphocytosis neutropenia monocytosis thrombocytosis |
| url | https://www.ijic.org/articles/5081 |
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