Pathology for clinicians and medical students: Difference between revisions

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*When ordering vitamin D levels, generally order '''calcifediol (25-hydroxycholecalciferol)''' and/or '''25-hydroxyergocalciferol''', and '''not calcitriol''' (also known as 1,25-dihydroxycholecalciferol). The latter is reserved for specific endocrinology purposes.
*When ordering vitamin D levels, generally order '''calcifediol (25-hydroxycholecalciferol)''' and/or '''25-hydroxyergocalciferol''', and '''not calcitriol''' (also known as 1,25-dihydroxycholecalciferol). The latter is reserved for specific endocrinology purposes.
*Don't order '''HbA1c''' in a patient who was '''transfused''' in the last 3 months, and consider a recent transfusion if a patient has a surprisingly normal HbA1c. In such patients, a fructosamine (glycosylated albumin) level is an alternative that is unaffected by transfusion, and reflects blood sugar control over the previous couple of weeks.<ref>{{cite web|url=https://www.clinicaladvisor.com/home/features/advisor-forum/post-transfusion-hba1c/|title=Post-transfusion HbA1c|author=Jennifer E. Frank, MD|website=ClinicalAdvisor}}</ref>
*Don't order '''HbA1c''' in a patient who was '''transfused''' in the last 3 months, and consider a recent transfusion if a patient has a surprisingly normal HbA1c. In such patients, a fructosamine (glycosylated albumin) level is an alternative that is unaffected by transfusion, and reflects blood sugar control over the previous couple of weeks.<ref>{{cite web|url=https://www.clinicaladvisor.com/home/features/advisor-forum/post-transfusion-hba1c/|title=Post-transfusion HbA1c|author=Jennifer E. Frank, MD|website=ClinicalAdvisor}}</ref>
*When ordering '''platelets''' or '''ref blood cells''', the patient will generally be transfused faster if you stick to the recommended dosage (generally one dose at a time, followed by a blood test to see the effect), rather than ordering excess units. With excess units ordered, even the first unit might be held up until blood bank staff has looked into the case in order to approve or reject the additional units.  
*When ordering '''platelets''' or '''red blood cells''', the patient will generally be transfused faster if you stick to the recommended dosage (generally one dose at a time, followed by a blood test to see the effect), rather than ordering excess units. With excess units ordered, even the first unit might be held up until blood bank staff has looked into the case in order to approve or reject the additional units.  
*See also: [https://www.choosingwisely.org/wp-content/uploads/2015/02/ASCP-Choosing-Wisely-List.pdf Thirty five major recommendations on test ordering (Choosing Wisely initiative 2020)]  
*See also: [https://www.choosingwisely.org/wp-content/uploads/2015/02/ASCP-Choosing-Wisely-List.pdf Thirty five major recommendations on test ordering (Choosing Wisely initiative 2020)]  
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