Donostia Unibertsitate Ospitaleko hematologiako kontsultetan 2015. urtean hobekuntza-planaren diseinuan lanean hasi ginen. Konturatu ginen bertan artatzen ziren kasu askok ez ziotela baliorik eransten, ez baitzuten patologia hematologikorik.

Hematologiako kontsultetara bereziki lehen arretatik iristen ziren pazienteak. Kontsultaren arrazoi usuena alterazio analitiko bat agertzea zen, hain zuzen kasuen % 60k analitikan sei alterazio hauetako bat zuen: gammapatia monoklonala, leukozitosia, linfozitosia, neutropenia, monozitosia edo/eta tronbozitosia.

Hematologiako eta lehen arretako medikuz eta erizainez osatutako lantalde bat sortu genuen. Sei alterazio analitiko horiek oinarri hartuta, dokumentu bat adostu zen. Dokumentu horretan idatzi ziren alterazio hematologiko horietako bat edo gehiago agertzen zuten pertsonei zer azterketa egin behar zitzaien eta lehen mailako osasun-zentroan ala hematologiako kontsultetan egin behar zitzaien jarraipena.

Ondoren, Donostialdea ESIko zenbait zentrotan aurkezpen-bilerak egin ziren eta bertan jasotako iritziekin behin betiko dokumentua adostu zen. Artikulu honetan bildu ditugu dokumentu horretan jasotako irizpideak. Dokumentua dinamikoa izatea nahi genuke eta erabilerarekin sortuko diren galderekin edo moldatu beharreko puntuekin dokumentua berritu eta eguneratuko dugu.

Hitz gakoak: Gammapatia monoklonala, Leukozitosia, Linfozitosia, Neutropenia, Monozitosia, Tronbozitosia

In 2015, we started working on the Improvement Plan of the Outpatient Clinic of the Hematology Department of the Donostia University Hospital. We noticed that many of the cases referred from primary care to the Hematology Department were inappropriate referrals as they had no hematological pathology. An analytical alteration was the main reason for referring patients from primary care. 60% of referred patients presented with one or more of the following 6 alterations according to their blood test: monoclonal gammopathy, leukocytosis, lymphocytosis, neutropenia, monocytosis and/or thrombocytosis. We set up a working group composed of primary care and hematological physicians and nurses. Together, we elaborated guidelines for the referral of patients presenting with any of these 6 analytical alterations. In this document, we suggested a series of studies to be carried out in Primary Care prior to referral, and indicate if follow-up should be carried out in a Primary Care center or in the Hematology Department. We presented this initial document in the Primary Care centers of Donostia and incorporated feedback into a final document. We would like this document to be dynamic and we will modify and update it with suggestions that emerge in response to its use.

Key words: monoclonal gammopathy, leukocytosis, lymphocytosis, neutropenia, monocytosis and thrombocytosis