Five hematologic tests and treatments to question

Area of Science:

• Hematology
• Medical Stewardship
• Evidence-Based Medicine

Background:

• Choosing Wisely(®) is a national initiative promoting appropriate medical care.
• The American Society of Hematology (ASH) previously released guidelines in 2013.
• There is a need to refine clinical practices based on the latest evidence.

Purpose of the Study:

• To present five new evidence-based recommendations from ASH for the Choosing Wisely(®) campaign.
• To guide clinicians and patients in questioning specific tests and treatments.
• To reduce unnecessary medical interventions and improve patient outcomes.

Main Methods:

• Utilized the established evidence-based methodology from the 2013 ASH Choosing Wisely(®) list.
• Reviewed current clinical evidence and expert consensus.
• Focused on specific hematologic conditions and common interventions.

Main Results:

• Recommendation 1: Limit anticoagulation to 3 months for first venous thromboembolic events with transient risk factors.
• Recommendation 2: Avoid routine transfusions for chronic anemia or uncomplicated pain crises in sickle cell disease.
• Recommendation 3: Do not perform baseline/surveillance CT scans for asymptomatic early-stage chronic lymphocytic leukemia.
• Recommendation 4: Avoid testing/treating for heparin-induced thrombocytopenia with low pretest probability.
• Recommendation 5: Treat immune thrombocytopenia only if bleeding or platelet count is very low.

Conclusions:

• These ASH Choosing Wisely(®) recommendations aim to optimize patient care by reducing unnecessary interventions.
• Clinicians and patients should engage in shared decision-making regarding these specific tests and treatments.
• Adherence to these guidelines can lead to more appropriate and effective hematologic care.