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Updated: Aug 2, 2025
Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management
Published on: January 19, 2024
[The cause of anemia is underdiagnosed in primary care]
Anne-Margreet de Jong1,2, Caitlin Bozic3, Firmin Candido4
1Atalmedial diagnostische centra, Amsterdam.
Insights
General practitioners often fail to diagnose anemia causes using lab tests. Insufficient follow-up and poor adherence to guidelines contribute to missed diagnoses in primary care.
Area of Science:
- Internal Medicine
- Hematology
- General Practice
Background:
- Anemia diagnosis in primary care relies on laboratory testing.
- The Dutch College of General Practitioners (NHG) provides guidelines for anemia diagnosis.
Purpose of the Study:
- To evaluate the diagnostic capability of general practitioners in identifying anemia causes based on requested laboratory tests.
- To assess adherence to the NHG-guideline for anemia diagnosis.
Main Methods:
- Retrospective observational study of 20,004 adult patients with anemia.
- Analysis of laboratory blood test requests and adherence to NHG-standard criteria.
- Descriptive statistics and multilevel regression analysis were employed.
Main Results:
- A cause for anemia was identified in only 38.7% of patients within two diagnostic requests.
- Adherence to the NHG-guideline was low, with only 59% following it in the first request and 1.2% in the second.
- Diagnostic success rates varied by age and sex, being lower in men.
Conclusions:
- Anemia causes are frequently undiagnosed in primary care due to insufficient laboratory follow-up.
- Poor adherence to the NHG-guideline for anemia diagnosis is prevalent.
- Improved diagnostic strategies and guideline implementation are needed.
Objective:
To determine if general practitioners can diagnose the cause of anemia, based on the requested laboratory tests.
Design:
Retrospective observational study.
Method:
The research population consisted of 20.004 adult patients with established anemia, who had blood samples analyzed by Atalmedial in 2019. The cause of anemia was found when criteria based on the NHG-standard were met. We considered the NHG-guideline to be followed when hemoglobin was requested in the first diagnostic request and when the correct combination of blood tests was requested in the second diagnostic request. Descriptive statistics and multilevel regression analysis were performed.
Results:
A possible cause of anemia has been found in 38,7% of the patients within two diagnostic requests, regardless of the adherence to the NHG-guideline. The chance of finding a cause of anemia was smaller in men than women of the same age, whereas the chance was highest in women over the age of 80 and between 18 and 44. The NHG-guideline for anemia was followed in 11.794 (59%) of the patients in the first diagnostic request. 19,3% (11,4% of total) of these patients also had a second diagnostic request. In 10,4% (1,2% of total) of these patients, the NHG-guideline was adhered to in the second diagnostic request.
Conclusion:
A cause of anemia is, based on laboratory tests, often not diagnosed in daily practice in the primary care. The reason for this is insufficient laboratory follow-up after initial testing when no cause of anemia is found. The NHG-guideline for anemia is poorly adhered to.
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