Laboratory Diagnostic Workup of Microcytic Anemia Evaluated

In microcytic anemia, the red blood cells (erythrocytes) contain less hemoglobin and are usually also hypochromic, meaning that the red blood cells appear paler than usual. This can be reflected by a low mean corpuscular hemoglobin concentration (MCHC).

During the last few decades, the number and availability of high-quality laboratory tests have gradually increased. Alongside this evolution some rather thoughtless and inappropriate use of these tests developed. Ordering tests with little to no use for patient care may even be harmful in terms of unnecessary follow-up diagnostics or treatments.

Medical Laboratorians at the Paracelsus Medical University Salzburg (Salzburg, Austria) evaluated the underuse and misuse of laboratory follow-up testing in a real-life hospital patient population with microcytic anemia, using laboratory results ordered during routine patient care. From all patients in whom a microcytic anemia was detected during routine diagnostics in 2018, all available laboratory data were collected and screened for appropriateness of diagnostic workup of iron deficiency and thalassemia. Subgroup analysis was performed for patient groups with mean corpuscular volume (MCV) values 75 to 79 μm3 (group 1), 65 to 74 μm3 (group 2), and <65 μm3 (group 3). The data were sequentially screened according to a query-algorithm, which was programmed into the AlinIQ system (Abbott Laboratories, North Chicago, IL, USA) to categorize patients according to the specified parameters.

The scientists reported that they had identified a total of 2,244 patients with microcytic anemia. Follow-up testing for iron deficiency was not performed in 761 cases (34%). For inconclusive ferritin levels due to elevated C-reactive protein results (n = 336), reticulocyte hemoglobin content or soluble transferrin receptor levels were missing in 86 cases (26%). In patients with suspected thalassemia (n = 127), follow-up testing for hemoglobin variants was not performed in 70 cases (55%). Subgroup analysis showed that the frequency of underuse of iron status as well as thalassemia/hemoglobinopathy testing decreased from group 1 to group 3. When considering relevant preexisting anemia diagnoses, laboratory tests were underused in 904 cases (40.3%).

The authors concluded that because 40% of the patients with microcytic anemia were potentially not followed up correctly, laboratory specialists are advised to act by implementing demand management strategies in collaboration with clinicians to overcome underuse of laboratory tests and to improve patient safety. The study was published in the January 2023 issue of the journal Archives of Pathology & Laboratory Medicine.

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