The ASH-ASPHO Choosing Wisely Campaign: 5 hematologic tests and treatments to question

Area of Science:

• Pediatric Hematology
• Medical Quality Improvement
• Evidence-Based Medicine

Background:

• Choosing Wisely is a national initiative promoting medical stewardship.
• The American Society of Hematology (ASH) partnered with the American Society of Pediatric Hematology/Oncology (ASPHO) to create pediatric-specific guidelines.
• The goal is to identify tests and treatments with low benefit and high cost or risk.

Purpose of the Study:

• To develop a list of 5 evidence-based recommendations for pediatric hematology care.
• To guide healthcare providers and patients in questioning unnecessary tests and treatments.
• To improve the quality and reduce the costs of pediatric hematologic care.

Main Methods:

• A joint ASH-ASPHO task force was formed.
• An iterative, evidence-based process was used to evaluate potential recommendations.
• Recommendations focused on tests and treatments lacking strong supporting evidence or offering low benefit.

Main Results:

• Five key recommendations were identified:
• 1. Avoid routine preoperative hemostatic testing in healthy children without bleeding history.
• 2. Avoid platelet transfusion for asymptomatic children with platelet counts >10 × 10³ /μL unless undergoing procedures.
• 3. Avoid thrombophilia testing in children with venous access-associated thrombosis and no family history.
• 4. Avoid packed red blood cell transfusion for asymptomatic children with iron deficiency anemia and no active bleeding.
• 5. Avoid routine granulocyte colony-stimulating factor for asymptomatic autoimmune neutropenia without severe infections.

Conclusions:

• Healthcare providers should carefully weigh the risks and benefits of specific hematologic tests and treatments.
• These recommendations aim to reduce unnecessary interventions in pediatric hematology.
• Implementing these guidelines can enhance patient safety and optimize resource utilization.