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Initial study of anaemia profile for primary care centres with automated laboratory algorithms reduces the demand for ferritin, iron, transferrin, vitamin B12 and folate tests
  1. J R Furundarena1,
  2. Alasne Uranga1,
  3. Carmen González1,
  4. Bruno Martínez1,
  5. June Iriondo1,
  6. Laida Ondarra1,
  7. Amaia Arambarri1,
  8. Ricardo San Vicente1,
  9. Cristina Sarasqueta2,
  10. Clara Lombardi1,
  11. Ane Altuna1,
  12. Nicolas Rois1
  1. 1Hematology Laboratory, Donostia University Hospital Aranzazu Building, San Sebastian, País Vasco, Spain
  2. 2Hematology Laboratory, Biodonostia Health Research Institute, Donostia-San Sebastian, Guipuzcoa, Spain
  1. Correspondence to Dr J R Furundarena, Hematology laboratory, Donostia University Hospital Aranzazu Building, 20014 San Sebastian, País Vasco, Spain; joseramon.furundarenasalsamendi{at}


Aim To evaluate the influence of an algorithm designed to incorporate reflex testing according to haemogram results for analytical tests ordered to investigate anaemia.

Methods In 2020, a new request for ‘initial study of anaemia’ was created in three primary care pilot centres for suspected anaemia or new anaemias. A haemogram was ordered and the remainder of the tests were created in a reflex manner according to an algorithm integrated in the laboratory information system that also generates a comment that is completed and validated by a haematologist. The demand for tests was evaluated over three time periods.

Results Of 396 requests, anaemia was detected in 80 (20.2%), with 26 microcytic anaemias (6.57%), 20 iron deficiency anaemias, 41 (10.3%) normocytic anaemias and 13 macrocytic anaemias (3.28%); 4 with folate deficiency; and 1 haemolytic anaemia. No haematological diseases were detected. Twenty-four (6.06%) cases exhibited microcytosis/hypochromia without anaemia, 12 of which exhibited iron deficiency. Four young women exhibiting within-limit haemoglobin levels had iron deficiency. There were 56 (14.1%) cases of macrocytosis without anaemia.

With the new profile of ‘initial study of anaemia’, the demand for tests was reduced and was significantly lower than in the remainder of primary centres for iron, transferrin, ferritin, vitamin B12 and folate.

Conclusions A new profile of ‘initial study of anaemia’ in the request form with algorithms integrated in the laboratory information system enabled submission of orders and decreased the demand for unnecessary iron, transferrin, ferritin, vitamin B12 and folate tests.

  • haematology
  • iron
  • medical informatics computing
  • vitamin B12

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  • Handling editor Mary Frances McMullin.

  • Contributors JRF, AU and CG designed the study and prepared the manuscript; BM, JI, LO, AmA, RSV, CS, AnA and NR contributed to data collection; and CS contributed to statistical analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Ethical Research Committee of the Sanitary Area of Gipuzkoa.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information. Data requesters should do the following: Email the corresponding author for the paper to request the relevant data.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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