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Thrombophilia test confusion

GPs are flooding thrombophilia testing services with inappropriate referrals because of lack of guidance, new research suggests.

GPs are flooding thrombophilia testing services with inappropriate referrals because of lack of guidance, new research suggests.

Two-thirds of requests for thrombophilia tests did not match any appropriate screening category, found an audit presented at the British Society for Haematology meeting in Edinburgh this week.

And a second study also presented at the conference found 64 per cent of patients with abnormal results were not appropriately managed in general practice.

Dr Adam Rye, consultant in haematology at Gloucestershire Hospitals NHS Foundation Trust, who carried out the screening audit, said: 'The results definitely show confusion.

'The criteria we audited against I would still consider fairly lax ­ over two-thirds didn't conform to even fairly permissive criteria. That's considerable resource usage.

'GPs can save themselves a lot of work and anxiety for work performed for no benefit.'

He added that many tests were done when results would not change management.

Dr Rubin Minhas, CHD lead for Medway PCT and a GP in Gillingham, admitted there was confusion: 'It is the sort of area where we do need guidance. Lack of consistency us- ually reflects lack of guidance.'

The audit, carried out in Bristol against criteria constructed from research findings and existing guidelines (see right), found 67 per cent of screening requests did not match any of the categories. Of the 113 requests, 58 per cent were received from general practice.

GP referrals were found to be the most inappropriate.

Separate research carried out in Kent confirmed high levels of inappropriate requests from GPs and also found only four of 11 patients with positive results were appropriately managed in primary care.

Study author Dr Karthik Ramasamy, specialist registrar in haematology at King's College Hospital, London, said. 'It's a matter of grave concern ­ if you're going to perform a test you have to follow it up.'

But Professor David Fitzmaurice, a GP and professor of primary care at the University of Birmingham and chair of the anticoagulation working group of the Primary Care Cardiovascular Society, advised GPs against any screening for thrombophilia.

'GPs should never be sending off for thrombophilia testing. If GPs are suspicious they should send patients to a specialist. Most of the time screening will not change your management.'

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