Automatic Laboratory-Initiated Reflex Testing to Identify Patients ...

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Froom et al / LABORATORY-INITIATED REFLEX TESTING FOR AIHA abnormal test results are compared with previous results if present in the database. In all patients without a history of anemia, we performed a reticulocyte count if the hemoglobin value was less than 10 g/dL (
❚Table 1❚ Univariate Analysis * led to considerable savings by decreasing physician visits. Cost-effectiveness, however, can be calculated only by determining the number of additional physician follow-up visits for patients who are not tested automatically. Negative consequences of automatic laboratory testing include redundant testing in approximately 20% of the patients with a positive direct antiglobulin test result, with previous positive test results in the hospital or from other areas in Israel. This might be prevented by improved computer integration of test results from other sources. Also, 87.7% of patients with elevated reticulocyte counts did not have a positive direct antiglobulin test result, and not all with a positive direct antiglobulin test result were treated. In these patients, additional test results outside the reference range could lead to negative consequences, including patient anxiety. Also, the effect of the test results on subsequent testing and treatment in patients without autoimmune hemolytic anemia needs to be studied because the added testing might have had positive or negative effects on patient care. We were unable to find clinical or CBC count variables that aid in limiting direct antiglobulin testing. Neither absolute reticulocyte counts nor corrected absolute reticulocyte counts were better than the more familiar uncorrected reticulocyte test. The cutoff for the degree of anemia needed to initiate a reticulocyte count is uncertain. It is possible that patients with a hemoglobin value of 10 g/dL (100 g/L) or more also might benefit from such testing. Further studies are warranted to substantiate our findings and to determine the proper cutoff for automatic direct antiglobulin testing. Extrapolation of our results to other settings should be done with caution. The upper end of the reference interval for reticulocytes in our laboratory is 1.9% (0.019) but has been reported variously to be 2.7% (0.027), 3 1.8% (0.018), 3 1.6% (0.016), 4 1.25% (0.013), 5 2.16% (0.022), 6 1.79% (0.018), 6 1.55% (0.016), 6 2.24% (0.022), 6 1.44% (0.014), 6 1.85% (0.019), 7 2.3% (0.023), 7 and 1.6% (0.016), 8 depending in © American Society for Clinical Pathology Coagulation and Transfusion Medicine / ORIGINAL ARTICLE Direct Antiglobulin Test Results Variable Positive (n = 52) Negative (n = 372) P Age (y) 60 ± 20 52 ± 25 .025 Female 35 (67.3) 244 (65.6) .807 Reticulocyte count, % of RBCs (proportion of RBCs) 6.5 ± 5.5 (0.065 ± 0.055) 4.7 ± 2.7 (0.047 ± 0.027)
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