血液学

西顿输液中心
DSMC-UT的一个部门
血液学标准

范围

• To provide specialty expertise in the evaluation and management of blood disorders beyond the scope of primary care physicians.
• To prioritize limited availability to patients with malignancies or complex hematologic disorders

Appropriate patients for referral include:

• Persistent, severe anemia after complete evaluation and treatment
• Severe and/or clinically significant
  • 血小板减少症
  • 血小板增多
  • 白血球减少症
  • 白细胞增多
• 单克隆丙种球蛋白病
• 镰状细胞病
• Hypercoagulable状态
• 凝血障碍

Documentation required for scheduling an appointment:

• Current medication list and co-morbidities or problem list
• Two most recent provider notes describing condition for which patient is being referred
• Recent pertinent labs (See worksheet by diagnosis, drawn within the past 6 months, substantiating the disorder.
• If previously treated by a Hematologist, send all hematology notes and previous treatment records.

Additional information needed from previous 6 months (IF APPLICABLE):

• Notes from all consultants (inpatient and outpatient)
• Discharge summaries from relevant hospitalizations
• 所有操作报告
• Diagnostic procedure reports (endoscopy, bronchoscopy, biopsies)
• 所有放射报告

See Worksheet below for more information

 血液学 Referral Worksheet

• Persistent, severe anemia after complete evaluation and treatment
  • Three consecutive CBC’s within the last year at least 1 month apart, most recent within 1 month of referral, with hemoglobin less than 10.0
  • TIBC, Ferritin, Serum Iron, B12 level, Folate level, TSH
  • Iron deficiency is not appropriate for referral unless a complete GI evaluation has been performed (colonoscopy and upper endoscopy)
  • Anemia of renal insufficiency should be treated by nephrologist and is not appropriate for referral
• 血小板增多
  • Three consecutive CBC’s within the last year at least 1 month apart, most recent within 1 month of referral
  • Persistent platelet count > 600
  • 外围涂片
  • Iron deficiency has been ruled out

• 血小板减少症
  • Three consecutive CBC’s within the last year at least 1 month apart, most recent within 1 month of referral
  • Persistent platelet count < 100, or two platelet counts < 50
  • 1 CBC in citrated (blue top) tube to evaluate for clumping

• 白血球减少症:
  • Three consecutive CBC’s within the last year at least 1 month apart, most recent within 1 month of referral
  • Persistent absolute neutrophil count less than 1500
  • Lymphopenia is not appropriate for referral
• 白细胞增多:
  • Three consecutive CBC’s within the last year at least 1 month apart, most recent within 1 month of referral
  • Physician documentation excluding infection
  • Persistent absolute neutrophil count > 20,000
  • Persistent absolute lymphocyte count > 10,000

• 单克隆丙种球蛋白病:
  • Serum protein electrophoresis (SPEP)
  • 血清immunofixation
  • Urine protein electrophoresis
  • CBC, CMP

• 镰状细胞病
  • Hemoglobin electrophoresis documenting diagnosis

• Hypercoagulable状态 (high risk thrombo-embolic event: DVT, PE, or atypical arterial event)
  • 所有放射报告 documenting thrombosis
  • Coumadin flowsheets if applicable
  • Specific question from referring physician, 在转介表格上填写, which is to be addressed by consultant

• 凝血障碍
  • Documentation of clinically significant bleeding
  • 所有相关实验室

修改后的11/2018