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Evidence-Based Oncology January 2017
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American Society of Hematology's Tenets for Hematologists to Choose Wisely
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American Society of Hematology's Tenets for Hematologists to Choose Wisely

Surabhi Dangi-Garimella, PhD
Initiated by the American Board of Internal Medicine, Choosing Wisely® is a campaign that has seen participation by a number of different national medical organizations to promote conversations between clinicians and patients to ensure adequate, evidence-based care.
7. Don’t routinely transfuse patients with sickle cell disease (SCD) for chronic anemia or uncomplicated pain crisis without an appropriate clinical indication.
Patients with SCD are more vulnerable to harms of RBC transfusion, such as alloimmunization to minor blood group antigens and iron overload. Patients with SCD whose baseline hemoglobin (Hb) ranges between 7-10 g/dl can tolerate further reductions without symptoms of anemia. Intravenous drips in these patients can further decrease their Hb, and so routine transfusion in these patients is contraindicated.

8. Don’t perform baseline or routine surveillance CT scans in patients with asymptomatic, early-stage chronic lymphocytic leukemia (CLL).
In patients with asymptomatic, early-stage CLL, baseline and routine surveillance CT scans do not impact survival and are not important to stage or prognosticate patients. CT scans expose patients to unnecessary radiation and may not provide clinically relevant information—in addition to being expensive. Instead, clinical staging and blood monitoring should be performed.

9. Don’t test or treat for suspected heparin-induced thrombocytopenia (HIT) in patients with a low pretest probability of HIT.
The 4Ts score–thrombocytopenia, timing of platelet count, thrombosis or other sequelae, and other cause of thrombocytopenia—is recommended to calculate the pretest probability of HIT in patients suspected of HIT. Further investigation is not recommended if the pretest 4T score is low (between 0 and 3). Heparin should not be discontinued or non-heparin anticoagulant should not be initiated in these low-risk patients.

10. Don’t treat patients with immune thrombocytopenic purpura (ITP) in the absence of bleeding or a very low platelet count.
Treatment for ITP should prevent bleeding episodes and improve patient quality of life. Unnecessary treatment can be harmful and costly–so decisions to treat ITP should be based on an individual patient’s symptoms, bleeding risk, social factors, side effects of possible treatments, upcoming procedures, and patient preferences. Unless an adult (platelet count greater than 30,000 µL) has to undergo surgery or other invasive procedures, or have a risk of bleeding, ITP is not indicated. 

REFERENCES
  1. Choosing Wisely®: An initiative of the ABIM Foundation. Choosing Wisely® website. http://www.choosingwisely.org/about-us/. Accessed December 21, 2016.
  2. American Society of Hematology: then things physicians and patients should question. Choosing Wisely® website. http://www.choosingwisely.org/societies/american-society-of-hematology/. Published December 4, 2013 and December 3, 2014. Accessed December 20, 2016.
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