There is, apparently, evidence that neurological features of b12 deficiency
can occur in the absence of anaemia and without serum b12 being reduced;
homocysteine or methylmalonic acid measurement are said to be a more
sensitive indicator of treatable b12 def in this circumstance.
-----Original Message-----
From: Rocks, Bernard [mailto:[log in to unmask]]
Sent: Monday, June 23, 2003 11:42 AM
To: [log in to unmask]
Subject: Re: overuse of haematinic tests
At least in Brighton, increased clinical activity in investigating and
treating causes of raised of homocysteine has lead to a justifiable, but
relatively small, increase in the number of requests for B12 and folate
measurement.
We also find the iron/transferrin index a useful aid in cases of
ironoverload/haemochromatosis.
Bernard Rocks,
Brighton and Sussex University Hospitals NHS Trust.
----------
From: Sharpe, Peter Dr [SMTP:[log in to unmask]]
Sent: Monday, June 23, 2003 9:18 AM
To: [log in to unmask]
Subject: Re: overuse of haematinic tests
We have also seen a large increase in requests for ferritin, B12 &
folate in
the absence of anaemia or micro/macrocytosis. Unfortunately, there
are few
(if any) guidelines around. Our Regional Audit group recently looked
at B12
& folate and found up to 18% of requests were for patients
complaining of
tiredness and lethargy in the absence of any haematological changes.
As far
as I can ascertain, there is no evidence to suggest that checking
B12 is
useful under these circumstances or that giving B12 injections is of
any
benefit in chronic tiredness (perhaps other than a placebo effect).
Similarly, are we going to treat all our low serum ferritins with
iron
supplements in the absence of anaemia/microcytosis?
I feel that this whole issue needs to be looked at particularly by
the
haematologists so that guidelines based on the best evidence are
drawn up.
Best wishes
Peter
PS We do not measure transferrin. We measure iron & TIBC
> ----------
> From: james falconer smith[SMTP:[log in to unmask]]
>
> Reply To: james falconer smith
> Sent: 20 June 2003 14:38
> To: [log in to unmask]
> Subject: overuse of haematinic tests
>
> The annual round of attempted cut backs is here again.
>
> Do any chemistry labs analyse B12, folate, ferritin, serum iron,
> transferrin?
> Do you have any clinical criteria about the use of these tests?
>
> We are thinking of dropping transferrin - the saving is worthwhile
> 25000 uk pounds per annum and little clinical impact (we believe).
>
> If anybody has any guidelines for the requesting of haematinics i
would be
> delighted to see them.
>
> A survey showed they were requested in 30-40% of all admissions -
that
> seems excessive from the lab perspective. Many of these patients
are not
> anaemic.
>
> thanks
> james falconer smith
>
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