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Iron Deficiency-Challenging to Diagnose: A Retrospective Chart Review of Referrals to Classical Hematology Clinic
Arianna S Moss1, Melissa Thomas2, Spencer Gibson2
1University of California Irvine School of Medicine, Irvine, CA, USA.
Insights
Diagnosing iron deficiency (ID) is challenging for primary care physicians, often leading to missed diagnoses and delayed treatment. This study highlights the need for improved ID detection to prevent adverse health outcomes.
Area of Science:
- Hematology
- Nutritional Science
- Internal Medicine
Background:
- Iron deficiency (ID) is a global health issue, recognized primarily for causing anemia.
- ID is an underappreciated cause of abnormalities in white blood cell and platelet counts.
- Early diagnosis of ID is crucial for preventing complications beyond anemia.
Purpose of the Study:
- To evaluate the diagnostic capabilities of physicians regarding iron deficiency.
- To identify challenges in the primary diagnosis of iron deficiency.
- To assess the impact of delayed ID diagnosis on patient health.
Main Methods:
- Retrospective chart review of 862 adult patients seen by a hematologist.
- Analysis of referring provider specialty, reason for referral, and final diagnosis.
- Iron deficiency defined by serum ferritin levels (<30 ng/mL or <100 ng/mL with inflammation).
Main Results:
- Out of 759 patients with complete workup, 304 (40.0%) were newly diagnosed with ID or iron deficiency anemia (IDA).
- Referrals came from internal medicine (21%), family medicine (18%), and other subspecialties.
- ID contributed to 54.7% of analyzed complete blood cell count abnormalities in a subset of patients.
Conclusions:
- Diagnosing iron deficiency presents a significant challenge for frontline physicians.
- Missed ID diagnoses can result in treatment delays and negative clinical outcomes.
- Improving the detection of iron deficiency is essential for public health.
Background:
Iron deficiency (ID) is the leading nutritional deficiency and a major public health concern globally. Although anemia is the most widely known consequence of ID, ID is also an underrecognized cause of white blood cell and platelet count abnormalities. The primary objective of the current study is to assess physicians' abilities to diagnose ID.
Methods:
This study is a retrospective chart review of 862 adults (mean age ± SD of 52.5 ± 18.4, 447 female) seen by a classical hematologist at an academic center. Data analysis included specialty type of the referring provider, referral reason, and the diagnosis made by the consulting hematologist. ID was defined as a serum ferritin level <30 ng/mL or <100 ng/mL in the presence of inflammatory comorbidities.
Results:
Out of 862 initial patient charts, 103 were lost to follow up before completing the workup. Out of the remaining 759 patient charts, 304 (40.0 %) patients received a new diagnosis with ID or iron deficiency anemia (IDA) by the consulting classical hematologist. Of these patients, 21 % were referred from internal medicine (IM), 18 % from family medicine (FM), 14 % from hematology-oncology for a second opinion, and 25 % from other IM subspecialties. In a sub-analysis of 364 patients who had complete blood cell count (CBC) abnormalities, ID was found to play a role in 54.7 % of CBC abnormalities analyzed.
Conclusion:
This analysis demonstrates that diagnosing ID is a challenge for first-contact physicians and may easily be missed. This leads to delays in ID treatment and resulting clinical consequences.
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