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Table 1 Descriptions of the seven pathology-specific laboratory profiles

From: Using pathology-specific laboratory profiles in Clinical Pathology to reduce inappropriate test requesting: two completed audit cycles

Table1: Profile

Profile description

1. Normal Adult Profile

An analysis of the literature shows that there is no rationale for ordering laboratory tests if there is no precise provisional diagnosis (or if a generic clinical suspicion is at least present) generated by the presence of symptoms, however vague and indistinct, such as asthenia, fever, and so on. In clinical trials in 1999 and 2005, the Japan Society of Clinical Pathology concluded that there was a great deal of diversity in the efficacy of the same profile when applied to different groups of patients, and that it was futile to order tests repeatedly in a single year. [7, 13] Patients often see undergoing laboratory tests as unavoidable, even when no clinical signs are present [14]. It is the combination of guidelines, policy modifications to laboratory access, and changes in payment policies that is associated with significant reduction of the use of laboratories.[15]

This profile consists of 8 parameters which examine the main organs or systems:

Haemopoiesis: the haemachrome has 30 parameters useful for identifying numerous pathologies;

Renal function: creatinine and complete urine test (itself containing 20 analytical parameters);

Overall metabolism: the total cholesterol and its fractions (HDL and LDL), gpt, glycaemia.

As we could not find any useful indications in the literature as to how often the profile should be repeated in a single year in a symptom-free subject, we set the maximum frequency for our healthcare setting at once a year.

2. Patient with Myeloma [16, 17]

Haemochrome, creatinine, protein electrophoresis, calcaemia - ß2 microglobulin – albumin, to be repeated once a year or if there is a change in the clinical situation.

Optional (but not useful in follow up):

Serum and urine immunofixation, Immunoglobulin measuring

3. MGUS [14, 18]

After initial classification

Electrophoresis once per year.

Reassess the patient to see if the clinical situation has changed.

4. Active chronic hepatitis

Normal Adult profile and Got as initial classification;

Gpt - Got - haemachrome in monitoring;

The serum tests for HBV and HCV are only performed for diagnostic purposes and are generally not repeated. [19, 20]

5. Thyroid

TSH by screening (with the exception of pregnant women).

Only if pathological TSH starts “Reflex Test” which include FT4/FT3 and, only in the first test, Antiperoxidase Antibodies. [21]

6. Hypertension

Normal Adult Profile (but optional)-na-k-cl-ca-uric acid;

TSH: as initial classification in those diagnosed with hypertension the first time. Normally repeated only if there is a change in the clinical conditions or treatment.

For monitoring we strongly recommend that only individual tests considered to be necessary are ordered (for example: creatinine, sodium, and potassium). [11]

7. Estro-progestogenic treatment

Normal Adult Profile is optional and not recommended.

Evaluation of V Leiden Factor and of mutation of the gene coded for Prothrombin (G20210A) is recommended only in patients with family history or pathological history of venous thrombosis. Conducted only once before initiating drug therapy. [12]