119 - Appropriateness in Laboratory Hematology

Autor(s): P. Cappelletti

Issue: RIMeL - IJLaM, Vol. 2, N. 2, 2006 (MAF Servizi srl ed.)

Page(s): 119-129

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”....

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