[The practice guideline 'Anemia' from the Dutch College of General Practitioners; a response from the perspective of general practice medicine].
The practice guideline 'Anaemia' from the Dutch College of General Practitioners will certainly be a support for the Dutch general practitioner. The inclusion of an algorithm to make a more precise diagnosis is an experiment that needs to be evaluated in the near future. However, many general practitioners will regard it as too complex for use in daily practice and specialists will find it to be of limited use, as it does not cover all cases. Consultation between the general practitioner and the specialist will give the best answer in complicated cases. Patients who complain about tiredness or dizziness will expect their general practitioner to take a blood sample for a haemoglobin test. The general practitioner will consider the risk of false-positive test results in interpreting the patient's haemoglobin level. A few concrete remarks: the guideline does not mention that vegetarianism and a low meat intake can increase the risk of vitamin B12 deficiency, and iron suppletion is advised in premenopausal women with profuse vaginal blood loss, whereas there are several treatable disorders that may cause menorrhagia.
van den Bosch
W J
WJ
Universitair Medisch Centrum St Radboud, afd. Huisartsgeneeskunde, Postbus 9101, 6500 HB Nijmegen. w.vandenbosch@hag.umcn.nl
D000465:Algorithms; D000740:Anemia / Q000175:diagnosis*; D003937:Diagnosis, Differential; D014676:Diet, Vegetarian; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008595:Menorrhagia / Q000175:diagnosis / Q000209:etiology; D009426:Netherlands; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'