119 - Appropriateness in Laboratory Hematology

Today an appropriate test is defined as one that will provide an answer to the clinical question, which enables the clinician to make a decision and initiate an action leading to health benefit for the patient. The appropriateness in Laboratory Hematology should consider the specific setting of the so-called “hematologic hematology” and “non-hematologic hematology”. The main issues for the appropriateness in Laboratory Hematology are the base of evidence of the large number of guidelines and recommendations for the best practice, and its application to the several steps of the total testing process. According to Galloway and Reid the issue whether the practice of hematology is evidence-based may have a positive answer for the therapeutic clinical practice, whereas the morphological diagnosis in hematology appears less evidence-based, for conceptual and cognitive reasons. For the hematological diagnostic testing, although the large bulk of literature, only few fields show up-to-date level-1 evidences. The practice of appropriateness during the pre-analytical phase approaches the forminG2 of the clinical question, the test selection, and the design of request forms that guide and teach. For the purpose of diagnosis many well-constructed algorithms and solid morphological evidences support the clinical and laboratory practice. Biological data and clinical researches demonstrate that the case finding in hematology is not appropriate. Often the monitoring of hematologic data does not follow the criteria derived from the cell biology and the established critical differences. Several works about request format show a lot of less or more complex ways to induce appropriateness, from the simplex exclusion of a test from the requisition form to a sophisticated reflex test as an “anemia cascade”....