On Location 2015 ASH Annual Meeting
“None of us in
medicine practice in a silo.
Many of the
diseases and
patients that we
treat overlap with
other specialties.”
—LISA K. HICKS, MD, MSc
Panelists discuss the ASH Choosing Wisely recommendations.
participated in the ABIM initiative, resulting in more than
380 individual recommendations.
“None of us in medicine practice in a silo,” she added.
“Many of the diseases and patients that we treat overlap
with other specialties, and many of the recommendations
that ASH has made are relevant to other specialties. The
reverse is also true, as we’ve shown with this new list.”
The five non-ASH Choosing Wisely recommendations with the greatest relevance to hematology are:
1. Don’t image for suspected pulmonary embolism (PE)
without moderate or high pre-test probability of PE.
(From the American College of Radiology)
Dr. Hicks: “Instead of using CT imaging, which is extremely helpful and powerful in the right circumstances,
in all patients, we should really be trying to isolate its use
to patients with moderate or high pretest probability of
PE. Current science supports the use of other clinical
tools, such as the Wells’ Criteria and certain laboratory
tests, to distinguish patients who would benefit from a CT
pulmonary angiogram to identify PE from those in whom
PE can be effectively ruled out without the use of CT.”
2. Don’t routinely order thrombophilia testing on patients
undergoing a routine infertility evaluation. (From the
American Society for Reproductive Medicine)
Dr. Hicks: “Infertility is extremely common, and it
typically occurs in otherwise healthy young women, so
we thought this was an important recommendation to
highlight.”
3. Don’t perform repetitive complete blood count (CBC)
and chemistry testing in the face of clinical and lab
stability. (From the Society for Hospital Medicine –
Adult Hospital Medicine)
Dr. Hicks: “Anyone who works in a hospital setting, like
I do, knows that a large amount of routine bloodwork
is done, and this has implications for patients. It can
contribute to anemia, it can be uncomfortable, and it
has cost implications. Bloodwork should be thoughtful
and intended to address a specific clinical question.”
4. Don’t transfuse red blood cells for iron deficiency
without hemodynamic instability. (From the American
Association of Blood Banks)
Dr. Hicks: “The patients I typically see with this condition are young women who may have iron deficiency
anemia due to menorrhagia. They may have significant
anemia, but because they are young and otherwise
healthy and have a very healthy hematopoietic system,
they are actually able to tolerate that. So, the AABB
recommends resisting giving red blood cells, unless a
patient is unstable or having chest pain or some other
marker of high risk, and giving iron instead.”
5. Avoid using positron emission tomography (PET) or
PET-CT scanning as part of routine follow-up care
to monitor for a cancer recurrence in asymptomatic
patients who have finished initial treatment to
eliminate the cancer unless there is high-level evidence
that such imaging will change the outcome. (From the
American Society of Clinical Oncology)
Dr. Hicks: “PET-CT is a very powerful new technology that is extremely helpful in certain circumstances,
but it has not been demonstrated to improve overall
survival or other important patient outcomes when
it is used as a surveillance technology. Using it in this
fashion also has important implications for cost, for
radiation exposure, and for the detection of incidental
findings – which can then cascade into a whole other
set of investigations.”
These lists are developed to aid clinicians and patients in
decision-making, but, Dr. Hicks noted, “None of the recommendations that we or anyone else makes in the realm
of Choosing Wisely replace clinical judgment.” ●
Catching Up With the ASH Annual Meeting First-Timer
In our December issue, we introduced you to Christina
Drenberg, first-time annual meeting attendee. We checked
in with Christina to find out how her first annual meeting
went and what she learned in Orlando, Florida. Christina is a
fifth-year postdoctoral trainee in the College of Pharmacy at
The Ohio State University.
What were your overall thoughts and impressions of the
meeting?
Overall, I thought the conference was well structured to accommodate so many attendees. I felt this meeting focused on clinical
findings rather than more basic or laboratory-oriented research.
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ASH Clinical News
Were you surprised by anything?
The number of abstracts. I found it difficult to see all of
the abstracts during the poster sessions. However, some of
that was due to great discussions with presenters.
What are your three takeaways from the meeting?
For a large conference, you definitely need to plan ahead,
take advantage of attending talks outside of your field,
and network.
Did you have an ah-ha moment? If so, what was it?
The sessions that I attended that were outside of my
field of research I found to be the most informative. I
learned of two mouse models that could be extremely
useful to my ongoing research.
What did you share with your colleagues/friends the day
you get back from the meeting?
I shared information regarding the mouse models that will
be useful in the future.
Will you attend this year’s meeting in San Diego?
If the funds are available, I will plan to attend.
February 2016