An Audit of Inpatient Consultations to a Hematology Department over Two-Year Period.

Background:

Inpatient consultation to hematologist increased in incidence and the role of hematologist as consultant continues to expand. But the resons for, frequency, and the result of inpatient hematologic consultation are largely unstudied. The aim of this study was investigation for the profiles of inpatients and their hematologic problems evaluated and managed by the hematology consultation of tertiary hospital.

Methods:

In this report, we evaluatded 354 consecutive patients with abnormal hematologic manifestation consulted for hematology department from March 2003 to Februery 2005. We prospectively recorded the demographics of the patients for whom consultation was requested, the reason of consultation, provisional diagnosis of the referring service, the final diagnosis and outcome of the patients in each case.

Results:

The consulted patients were 354 among 55,704 inpatients (0.6%). Approximately half the patients were female (54%). The median age was 55 years (range: 16–85) and the most frequent age group was the 6^th decade. The median length of hospitalization was 26 days (range: 4–188) and the median interval from admission to initial consultation was 6 days (range: 1–76). In a third cases of consultations, the hematologic abnormalities were found newly after admission. The departments requesting consultation frequently were neurosurgery (24%), general surgery (11%), divisions of internal medicine (11%), orthopedic surgery (9%), and neurology (9%). The common causes of consultation were as follows: anemia (29%), thrombocytopenia (21%), pancytopenia/bicytopenia (16%), coagulation abnormality (15%) and thrombocytosis (7%). While anemia was the most common reason of consultations from medical services (internal medicine, neurology, psychology, rehabilitation medicine, etc), thrombocytopenia and coagulopathy were the frequent reasons of consultations from surgical services (general surgery, orthopedic surgery, plastic surgery, neurosurgery, etc.). The best part of anemia were IDA (43%) and anemia of chronic disease (33%). Drugs made up 38% of the cause of thrombocytopenia and the suspected drugs were anticonvulsants and antibiotics. A half of pan/bicytopenia were caused by drug-related or vitB12/folate deficiency. 40% of coagulopathy resulted from nonspecific or undefined cause. Bone marrow examination was required in 30 cases (8%). Careful evaluation of patients with hematologic problem sometimes revealed occult bleeding, liver disease or hematologic disease such as myelodysplastic syndrome, immune thrombocytopenic purpura or chronic myeloproliperative disorder. Almost physicians avoided making presumptive diagnoses and requested consultation for abnormal laboratory findings, leaving it to the hematologist to determine the cause.

Conclusion:

Although It provides a small cross-sectional findings of the types of patients and problems seen by hematologist during inpatient consultation, these informations may be helpful to provide optimal inpatients care for hematologist and to improve the quality of the consultation process by the referring service.