You Make the Call: Readers’ Response
Calendar
European Hematology Association
Annual Congress
June 14 – 17, 2018
Stockholm, Sweden
The 23rd Annual Congress covers every subspecialty
in hematology with experts from around the world.
The educational and scientific program will highlight
up-to-date clinical practice and the latest findings in
hematology research.
International Conference on
Lymphocyte Engineering
September 13 – 15, 2018
Madrid, Spain
This conference brings together immunotherapy with
cell and gene therapy to foster interdisciplinary col-
laborations and deepen the connection between basic
and clinical research across related disease specialties.
19th Meeting of the European
Association for Haematopathology
September 29 – October 4, 2018
Edinburgh, Scotland
EHAP: 2018’s interdisciplinary program includes an
educational session, as well as bone marrow and
lymphoma symposia and workshops. The latest
scientific discoveries pertinent to the themes of the
meeting will be highlighted and related to practical
issues in diagnostic hematopathology.
ASH Summit on Emerging Immunotherapies
for Hematologic Diseases
July 12 – 13, 2018
Washington, DC
ASH’s newest meeting examines preclinical and
clinical factors influencing the effective development,
regulation, and implementation of immunotherapies
for hematologic diseases.
ASH Meeting on Lymphoma Biology
August 2 – 5, 2018
Chantilly, VA
This meeting brings together experts from around the
world to discuss the latest lymphoma fundamental
science, address challenges in the field, establish the
highest priorities for investigation, and develop novel
therapeutics.
American Association of Blood Banks
Annual Meeting
October 13 – 16, 2018
Boston, MA
The AABB Annual Meeting is an educational and
networking event for health care providers in the
field of transfusion medicine and cellular therapy.
Opportunities for continuing education focus on
optimizing patient and donor care and safety.
CAP18: The Pathologists’ Meeting
October 20 – 24, 2018
Chicago, IL
The College of American Pathologists’ 2018 meeting
brings together pathology and laboratory medicine
experts from around the world.
American Society for Radiation Oncology
Annual Meeting
October 21 – 24, 2018
San Antonio, TX
ASTRO’s 60th Annual Meeting creates a forum for
global collaboration on issues in radiation oncology.
We asked, and you answered! Here are a few responses
from this month’s “You Make the Call.”
For the full description of the clinical dilemma, and to
see how the expert responded, turn to page 32.
Clinical Dilemma:
I am evaluating a 60-year-old man for cervical spine
surgery who has a prolonged prothrombin time (PT) and
appears to have mild factor VII (FVII) deficiency. He has
no problems with minor lacerations (e.g., shaving) and is physically active. The initial
abnormality that prompted referral was a baseline PT of 15.2 seconds, international nor-
malized ratio (INR) of 1.3, with normal partial thromboplastin time. Repeat PT was 13.8
seconds, INR 1.2, with the following factor levels: FVII 46 percent, factor II 86 percent,
factor V 87 percent, and factor X 87 percent. The FVII deficiency literature suggests that
surgical bleeding is rare if FVII is above 10 percent. One discussion suggested that 30
percent should be okay, but I am concerned about this being a critical bleeding site.
I would consider giving tranexamic acid
as prophylaxis preoperatively and a dose
postoperatively.
Santosh Saraf, MD
University of Illinois Health
Chicago, IL
Roy Silverstein, MD
Medical College of Wisconsin
Milwaukee, WI
Panju Prithviraj, MD
Port Clinton, OH
2018 American Society of Hematology
Annual Meeting
ASH Meeting on Hematologic
Malignancies
September 7 – 8, 2018
Chicago, IL
Top experts in hematologic malignancies discuss
the latest developments in clinical care and provide
answers to your most challenging patient-care
questions in a small-group setting. The program
content is structured as “How I Treat” presentations,
which showcase each speaker’s evidence-based
treatment approaches.
ASHClinicalNews.org
December 1 – 4, 2018
San Diego, CA
The 60th ASH Annual Meeting and Exposition will
provide an invaluable educational experience and
the opportunity to review thousands of scientific
abstracts highlighting updates in the hottest topics in
hematology.
Ranga Brahmamdam, MD
TriHealth Cancer Institute
Cincinnati, OH
Needs perioperative recombinant FVIIa.
I would do a mixing study and acute pro-
myelocytic leukemia workup, as this could
be a presentation of anti-threonyl-tRNA
synthetase syndrome and would make me
consider thromboprophylaxis. If mixing
corrects the PT, I would not treat but would
observe carefully.
I would be cautiously optimistic and
clear him for surgery, ready to follow and
treat, if there is clear evidence. There is
more than usual bleed seen with this
kind of surgery.
MARK YOUR CALENDAR
I do not see any need for any interven-
tion. Proceed with surgery.
There are several mutations in the FVII
gene that cause prolongation of the PT
and are associated with low FVII activ-
ity that are of limited (if any) clinical
significance (e.g., FVII Padua). These
mutations affect the interaction of FVII
with rabbit or bovine brain thrombo-
plastin that is frequently used as the
activator for the PT and FVII activity
assay. The PT and FVII activity are within
reference limits when performed using
recombinant human tissue factor (Inno-
vin). This would also account for the lack
of significant abnormal bleeding history
in this patient. No need for treatment to
prevent abnormal bleeding if PT and FVII
activity are normal using Innovin as the
activator in the PT and FVII assay.
Michael H. Creer, MD
Penn State Health
Hershey, PA
Kelty Baker, MD
Houston Methodist
Houston, TX
Due to a high-risk surgery on the C-spine,
I would recommend administering fresh
frozen plasma preoperatively in a loading
dose of 15 to 20 mL/kg, followed by 5
mL/kg every 8 to 12 hours, for a few days
until wou nds heal.
Natalia Neparidze, MD
Yale School of Medicine
New Haven, CT
With a FVII level of almost 50 percent
and a hemostasis that has already
proved intact on several occasions, I
would advise surgery without any bleed-
ing prophylaxis.
Imre Bodó, MD, PhD
Winship Cancer Institute of Emory University
Atlanta, GA
Sounds like he will do fine, based on
his previous history. One might want to
have factor VIIa available. I would also
be concerned about a post-operative
DVT/pulmonary embolism, like any
other patient having this type of surgery.
Steven Sandler, MD
Advocate Health Care
Skokie, IL
See more reader responses at
ashclinicalnews.org/you-make-the-call.
ASH Clinical News
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