Classical Hematology: Not so Easy! Call for Expert!

Background:

Studies have previously shown that the addition of a sickle cell specialist to the management team for patients with Sickle Cell Disease improved health outcomes and healthcare utilization (1). This data analysis evaluates the patient outcome when a classical hematologist is added to the management team for patients with non-cancer blood disorders, given that current projections suggest the demand for adult hematologists will exceed the existing supply in the United States (2).

Methods:

This study is a retrospective chart review of 759 adults (mean age +/SD of 52.5 years +/- 18.4, 447 females) seen between February 2020 and July 2023 in a single-provider non-cancer hematology clinic at an academic center. Data collected included type of referring provider specialty, referral reason or diagnosis, diagnosis made by the classical hematologist, new additional contributing diagnoses, and new unrelated incidental findings discovered during the work up.

Results:

Of the 759 patients seen by the classical hematologist, 356 patients (group A) were referred for management advice or confirmation of the diagnosis, and remaining patients (group B) were referred seeking a diagnosis. Of note, 18% of the 759 referrals were from another hematologist/oncologist seeking a second opinion. During work up for group A, the diagnosis was changed in 34 patients (9.6%), one or more new contributing causes for their referral reason were discovered in 89 patients (25%) and 80 patients (22.47 %) were found to have one or more new unrelated but clinically significant diagnosis. In 99.26% of patients in group B, a visit to the classical hematologist led to a new diagnosis to address the reason for referral; 55% of patients had only one diagnosis while in remaining patients’ the diagnosis was found to be multifactorial. During workup for group B, at least one new incidental but clinically significant finding was discovered in 16% of patients.

Conclusion:

This data demonstrates that adding classical hematologists to the care team improves diagnostic evaluation and management of patients with non-cancer blood disorders and their overall quality of care. The significant number of referrals from hematology/oncology to classical hematologists indicates their value seen from within the field and the clear need for their expertise.

References

1. Deva Sharma, Natalie Wallace, Erik A. Levinsohn, Ariela L. Marshall, Karen Kayoumi, Johanna Madero, Morgan Homer, Robby Reynolds, Janet Hafler, Nikolai A. Podoltsev, Alfred Ian Lee; Trends and factors affecting the US adult hematology workforce: a mixed methods study. Blood Adv 2019; 3 (22): 3550–3561. doi: https://doi.org/10.1182/bloodadvances.2019000307
2. Mainous AG 3rd, Rooks B, Tanner RJ, Carek PJ, Black V, Coates TD. Shared Care for Adults with Sickle Cell Disease: An Analysis of Care from Eight Health Systems. J Clin Med. 2019 Aug 2;8(8):1154. doi: 10.3390/jcm8081154. PMID: 31382365; PMCID: PMC6723540.