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Choosing Wisely: Hematologic Tests and Treatments

December 9, 2013

Choosing Wisely: Hematologic Tests and Treatments

  1. David Green, MD, PhD

Evidence-based recommendations from the American Society of Hematology on five tests and treatments to avoid

  1. David Green, MD, PhD

Tests and treatments using evidence-based data for practice improvement is an important clinical goal. The Choosing Wisely campaign of the American Society of Hematology selected the following five common tests and treatments that might be inappropriate in certain circumstances and should be avoided, based on the evidence from systemic reviews and expert opinion:

  • When transfusion of red blood cells is indicated, use the minimum number of units needed to relieve symptoms; the goal in stable, non-cardiac patients is a hemoglobin of 7 to 8 g/dL.

  • Testing for thrombophilia is not indicated when venous thromboembolism occurs in the setting of surgery, trauma, or prolonged immobility.

  • The routine use of vena cava filters in patients with acute venous thromboembolism is discouraged.

  • Fresh frozen plasma or prothrombin complex concentrates should not be given to reverse vitamin K antagonists other than for major bleeding, intracranial hemorrhage, or anticipated emergent surgery.

  • In asymptomatic patients following curative-intent treatment for aggressive lymphoma, limit the use of surveillance CT scans.

Comment

Each of the above recommendations is supported by a discussion of the risks and benefits of the test or treatment. For example, there is no published evidence that liberal transfusion improves patient outcomes. The detection of a thrombophilic disorder does not alter the duration or intensity of treatment for venous thromboembolism and might lead to inappropriate testing of family members. Vena cava filters are not a treatment for lower extremity venous thrombosis, and their use to prevent pulmonary embolism in patients without lower extremity venous thrombosis is not well-supported by clinical trials and is potentially harmful. In non-bleeding patients with prothrombin times above the therapeutic range, warfarin should be withheld and small oral doses of vitamin K administered. Lastly, there is no evidence of a survival benefit from surveillance scans in patients with aggressive lymphomas, but there is evidence that radiation exposure from repeat CT is harmful. Adherence to the Choosing Wisely recommendations will improve patient care and reduce costs.

  • Disclosures for David Green, MD, PhD at time of publication Consultant / Advisory board Altor Bioscience Grant / research support NIH

Citation(s):

Reader Comments (4)

HAMID IQBAL MBBS, FCPS Other Healthcare Professional, Hematology, Armed Forces Hospital Jazan

A very informative article which guides for the routine matters in clinical practice

SHIWAJI PAWAR

similar article in pediatric hematology

Susan Milliken, D.O. Physician, Internal Medicine, Randolph, Mass

I have experienced in my practice at least two cases of coagulopathy from family testing after DVT that impacted the family members lives ( one a young girl with miscarraiges)// Still consider doing Thrombophilic testing on all patients and their families as it may prevent morbidity

Ricardo Benzadón Physician, Hematology, CEMIC

Para re-enviar a todos los hematólogos

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