Sa1262 A New Prognostic Model for Enteropathy Associated T-Cell Lymphoma

Background: Celiac disease (CD) is associated with significant morbidity and mortality and is considered to be under-diagnosed in the United States.Iron deficiency anemia (IDA) is an increasingly recognized presentation of CD.There are no guidelines in the literature for screening for CD among those with IDA in the US.We therefore surveyed practicing hematologists to determine rates of CD screening in patients diagnosed with IDA.Methods: A survey was developed by four gastroenterologists, a hematologist, and two medical residents.It was tested on hematologists for content and ease of use.It was submitted via surveymonkey.comand emailed to members of the American Society of Hematology.Questions included demographics, workup of hypothetical patients, and agree/disagree statements.We constructed a multivariate model to assess for independent associations between years in practice, subspecialty, patient volume, and patient age on providers' attitudes regarding screening for CD.The dependent variable was the response "agree" or "strongly agree" to the statement "all patients with IDA should have celiac serologies sent."Results: There were 385 complete responses from 4551 emails for a response rate of 8.5%.Most respondents were practicing clinicians (76%), followed by clinical researchers (10%), and laboratory researchers (6%).Benign hematologists accounted for 45% of respondents, followed by oncologists (33%) and malignant hematologists (22%).The most common practice types were university-affiliated hospital (43%), private clinic (29%), community hospital (12%), and VA hospital (9%).Most respondents saw an average of 3-5 (31%) or 6-10 (28%) patients with IDA per month, with an average patient age of 31-50 (47%) followed by 51-70 (34%).In the evaluation of hypothetical patients with IDA, only 18% were likely to test for CD in 45 year old premenopausal women, while 12% would test 55 year old postmenopausal women.Only 8.6% of respondents believe that all patients with IDA should be screened for CD.Respondents with 0-5 years in practice since completion of training were more likely than all other respondents to screen for CD (16% vs 7%, OR=2.4,p=0.05).Higher volumes of IDA patients per month also significantly increased the likelihood of screening for CD (OR 5.6, p=0.01).In multivariate analysis, both malignant hematologists (OR 3.2, CI 1.1-9.5, p=0.04) and oncologists (OR 3.5, CI 1.3-9.5, p=0.02) were more likely than benign hematologists to screen all patients for CD, as were those who saw predominately pediatric patients with IDA versus adult patients (OR 16.9, CI 3.0-97.0,p=0.002).Conclusions: Practicing hematologists infrequently screen for CD in patients with IDA.Physicians that have recently finished fellowship are more likely to screen for CD as are those who see a high volume of patients with IDA.