Current And Future Diagnostics Of Anaemia

Anaemia is often encountered in general practice but the prevalence of the different aetiology remains elusive. We analysed a large database of general practice patients newly diagnosed with anaemia, allowing for the detailed study of the prevalence of a wide range of causes and a thorough discussion of the value of MCV in the evaluation of anaemia. A detailed analysis of the impact of the different causes on mortality risk of anaemic general practice patients was performed as well as a separate analysis of the aetiology and mortality risk found in the macrocytic cohort of our population. Lastly an analysis of the adherence of general practitioners to the guidelines regarding the diagnostics and treatment of anaemia of chronic disease and iron deficiency anaemia, both highly prevalent in our population, was conducted.

Morphological assessment of the peripheral blood smear is often part of anaemia evaluation, especially when a bone marrow disease is considered as the underlying cause. We conducted two steps of the validation process of digital microscopy (DM) systems, which allow for the automated and standardized assessment of peripheral blood smears. The inter-laboratory reproducibility between four DM systems was studied, followed by a details analysis of a large leukocyte database, consisting of 1.4 million cells. This database was used to determine the accuracy of DM systems for a wide range of leukocyte classes, compared to manual morphological assessment, the current gold standard.

This thesis provides reliable prevalence rates of a wide range of possible causes of anaemia and details their impact on mortality risks. More information on these topics will hopefully bring a greater awareness of the potential danger of anaemia to a patient. In addition, two steps in the validation of DM systems for use in routine practice are described. The implementation of these systems will allow for a standardized and automated differential in diagnostic laboratories.