Background: There are no updated guidelines on HT testing. Interpretation and clinical relevance of results pose difficulty for clinicians who frequently seek advice from haematologists who in turn consult the British Society of Haematology guidelines on HT from 2010.
Positive results can cause anxiety for patients and their families. Further testing is frequently required followed by a review increasing burden on healthcare overall in an area where clinical evidence is lacking.
In our laboratory, HT test kit comprises protein C, S, AT deficiency and APC resistance at a cost of £59.13.

Aims: Identification of categories prompting an HT screen
Impact on management
Cost

Methods: All HT requests at Peterborough City Hospital from 1.1.2018 to 31.12.2018 were reviewed for indication, age, effect on management and cost.

Results: We received 424 requests. 418 were analysed. 256 (61.2%) were not indicated.
The remaining were for “soft indications”; 42 (10%) for unprovoked VTE in patients under 50, 38 (9%) for miscarriages and early pregnancy loss, 38 (9%) in patients with family members with thrombosis, one arterial thrombosis under 50, and one had no clinical details.
28 tests came back positive. 3 patients with miscarriages or early pregnancy loss tested positive for FV Leiden which impacted on management (low molecular weight heparin would be prescribed).
Two unprovoked VTE patients with protein S deficiency and AT deficiency received lifelong anticoagulation based on the results. In the latter case, first degree relatives were tested.
The remaining 23 abnormal results did not affect management.

Conclusions: 98.8% of tests had no impact on management. Total cost was £24,716.34.
Inappropriate tests cost £15,137.28. Tests in the “soft indications” category cost £9519.93.
We plan to screen all requests and limit testing to FV Leiden in miscarriages and pregnancy loss and HT screen only in selected patients with unprovoked VTE.
Potential savings are £24420.69 (98.8% of cost).

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/are-we-choosing-wisely-heritable-thrombophilia-ht-testing-in-a-district-general-hospital-in-the-uk/