Aim There is currently no national guidance for which blood tests should be performed at annual review for individuals with coeliac disease. NICE and BSPGHAN recommend ‘monitoring for complications’ and ‘assessing the need for specific blood tests’ but do not specify which tests. Our aim is to compare blood tests at our district general hospital with a local tertiary centre to develop a cost-effective strategy for long-term follow-up of patients with coeliac disease.
Method We accessed records of all children with coeliac disease. We reviewed which blood tests were performed at annual review and how many of these were abnormal. We calculated the total cost of annual review bloods and compared this to our local tertiary centre.
Results 42 patients with coeliac disease are seen for annual review. 40 were seen jointly in clinic with a consultant and dietician. B12, folate, vitamin D, ferritin and TFTs were additional tests performed by ourselves and not routinely at our local tertiary centre. Of these, a significant proportion were abnormal. B12/folate (15.3% abnormal, 100% of these treated ) and ferritin (51.2% abnormal, 76.2% of these treated)
Conclusion We perform more blood tests than our local tertiary centre. These amount to £49.53 per patient per annum, compared with £28.41. However, we are also detecting and treating more nutritional deficiencies. We recommend a proforma for each patient at their annual review detailing symptoms, height, weight, blood results and support groups. We recommend urine dipstick for glycosuria to replace serum glucose and only CRP and TFTs in patients when clinically indicated. These changes would save £344.40 per annum.
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