Management of anemia in a general city hospital: value of chart review in establishing deficiencies in care.

A retrospective review was done of the charts of 50 persons admitted to hospital for investigation of primary anemia. The duration of hospital stay was considered excessive for 80% of the patients and investigation was considered excessive for 34%. Nevertheless, underdiagnosis or misdiagnosis by the time of discharge was evident in 48% and was the result of inadequate investigation or faulty analysis of the results or both. Even when the type of anemia was established, investigations to determine the cause of specific deficiencies were frequently inadequate. Understandably treatment was inadequate for undiagnosed or misdiagnosed conditions but it was also inadequate for many correctly diagnosed conditions. Parenteral administration of iron was prescribed more often than oral administration, and 30% of patients with iron deficiency anemia failed to receive iron by either route. Most patients with vitamin B12 deficiency anemia received treatment late. Blood transfusion was given to 40% of patients but could be justified in only 16%.