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December 19, 1977

Clinical Laboratory Use in the Evaluation of Anemia

Author Affiliations

From the Department of Laboratory Medicine (Drs Wheeler, Brecher, and Sheiner) and the Division of Clinical Pharmacology, Department of Medicine (Dr Sheiner), University of California Medical Center, San Francisco.

JAMA. 1977;238(25):2709-2714. doi:10.1001/jama.1977.03280260039014

Follow-up tests ordered on 258 consecutively examined inpatients with low hemoglobin values on admission were analyzed. The appropriateness of the follow-up tests was evaluated by chart review after preselection by an algorithm. When the cause of the anemia was known or was irrelevant in view of the patient's clinical status, the laboratory use was judged to be adequate. Seventy-one percent of patients studied had an adequate follow-up, though 11% had nonindicated tests performed, scored as laboratory overuse. Twenty-four percent had no follow-up, scored as laboratory underuse. Five percent did not have all indicated tests done and had nonindicated tests done, scored as a mixture of underuse and overuse. Potential remedies to correct misuse are discussed.

(JAMA 238:2709-2714, 1977)