Pattern of Consultation Referrals for Cytopenia Evaluations to a Hematologist at An Academic Medical Center: The Expanding Role of a Consultant Hematologist

Purpose: It appears that many cytopenia consultation referrals to Hematology outpatient clinics turn out to have diseases related to primary care practice. The aim of this retrospective study is to see what proportion and what kind of cytopenia consultations in a Hematology clinic are due to disorders related to primary care practice.

Methods: Retrospective chart review analysis of all outpatient referrals from July 2002 to June 2008 to a Hematologist at a tertiary university hospital was performed. Of those, only cytopenia consultations were analyzed. Cases were analyzed according to the presenting cytopenias and the final diagnoses.

Results: There were a total of 942 outpatient consultation referrals during this period. 435 consultations were for cytopenia evaluations (46%). Of cytopenia evaluations, the demographics were as follows; male: female = 1: 1.5, age: <60: >60 = 1:1, Caucasian: non-non-Caucasian = 3:1. Distributions of cytopenia consultations were as follows: anemia (60%), thrombocytopenia (15%), leucopenia (10%), pancytopenia (6%), anemia and thrombocytopenia (4%), anemia and leucopenia (2.5%), leucopenia and thrombocytopenia (2.5%). Fortysix cases of cytopenia (11%) resolved on its own without any intervention. Final diagnoses of the rest were iron deficiency anemia 28% (65 cases of gastrointestinal bleeding, 47 cases of menorrhagia, 5 cases due to malabsorption, 5 cases of vegetarianism), myelodysplasia 8%, anemia of multifactorial origin (> more than 1 cause) 7%, anemia due to chronic renal failure only 6%, anemia of chronic disease 2%, drug-induced myelosuppression 6%, ITP 5%, ethnic leucopenia 4%, vitamin B12 deficiency 3%, thalassemia 3%, acute leukemia 2%, myeloma 2%, cirrhosis/hypersplenism 2%, sickle cell/hemoglobinopathy 1.5%, gestational thrombocytopenia 1.5%, viral hepatitis 1%, hereditary spherocytosis 1%, hemolytic anemia 1%, low grade lymphomas 1%, myelofibrosis 1%, non-immune chronic idiopathic neutropenia of adult 1%, immune leucopenia 0.5%, human immunodeficiency virus infection 0.5%, alcoholism 0.5%, paroxysmal nocturnal hemoglobinuria 0.25%. Primary hematologic diseases accounted for 34.25% while the remaining cases were diseases related to primary care practice.

Conclusion: Cytopenia consultations accounted for 46% of all referrals. Anemia made up the majority of cytopenia consultations. Iron deficiency anemia due to gastrointestinal bleeding turned out to be the commonest final diagnosis while iron deficiency anemia due to menorrhagia was the second commonest diagnosis. Two-thirds of cytopenia consultations turned out to have diseases related to primary care medicine while primary hematologic diseases accounted for only one-third of the consultations. It appears hematologists are seeing more and more cases of cytopenias due to primary medical diseases (hematologic manifestations of medical diseases) rather than true primary hematologic disorders. Thus, the hematologist’s role as a consultant to primary care practitioners continues to expand.