Group aims to encourage physician and patient conversations by identifying five
tests or procedures to question, highlighting potentially unnecessary--sometimes
harmful--practices in hematology
WASHINGTON, Dec. 4, 2013 /PRNewswire-USNewswire/ -- The American Society of
Hematology (ASH), the world's largest professional organization dedicated to the
causes and treatments of blood disorders, today released a list of common
hematology tests, treatments, and procedures that are not always necessary as
part of Choosing Wisely(R), an initiative of the ABIM Foundation. The list, also
highlighted in a manuscript published online today in Blood, the Journal of the
American Society of Hematology, makes five evidence-based recommendations in an
effort to prompt conversations between patients and physicians about the
necessity and potential harm of certain practices. ASH's Choosing Wisely list
(available at www.hematology.org/choosingwisely) identifies the following five
tests, treatments, and procedures that hematologists and their patients should
-- Limit surveillance computed tomography (CT) scans in asymptomatic
patients following curative-intent treatment for aggressive lymphoma.
-- Don't use inferior vena cava (IVC) filters routinely in patients with
acute venous thromboembolism (VTE).
-- Do not transfuse more than the minimum number of red blood cell (RBC)
units necessary to relieve symptoms of anemia or to return a patient to
a safe hemoglobin range (7 to 8 g/dL in stable, non-cardiac,
-- Don't test for thrombophilia in adult patients with venous
thromboembolism (VTE) occurring in the setting of major transient risk
factors (surgery, trauma or prolonged immobility).
-- Don't administer plasma or prothrombin complex concentrates for
non-emergent reversal of vitamin K antagonists (i.e. outside of the
setting of major bleeding, intracranial hemorrhage or anticipated
The ASH Choosing Wisely list was developed after months of careful data analysis
and review as well as input from the ASH membership, using the most current
evidence about management and treatment options, with the goal of starting a
conversation both within the hematology community and among physicians and their
patients about quality of care.
"Hematology is a specialty with many new and increasingly expensive tests and
treatments. While these new diagnostic and treatment strategies represent
important advances, there is also potential to pose significant harm and cost to
patients if over- or misused," said Lisa Hicks, MD, of St. Michael's Hospital
and the University of Toronto and chair of the ASH Choosing Wisely Task Force.
"The ASH Choosing Wisely list serves as a reminder to hematologists to take a
step back and question whether certain routinely used procedures are really
necessary, and to gradually change their practices to maximize the value of
One element unique to ASH's list is the concept of avoiding harm as the dominant
guiding principle for the rigorous selection process for list items. The four
other established guiding principles of the Choosing Wisely campaign are
evidence, cost, frequency, and scope of practice. Therefore, those tests,
procedures, or treatments deemed as increasing risk of harm were prioritized for
inclusion on ASH's Choosing Wisely list.
"ASH has shown tremendous leadership by releasing its list of tests and
procedures that are commonly performed in hematology but aren't always
necessary," said Richard J. Baron, MD, president and CEO of the ABIM Foundation.
"The content of this list and all of the others developed through this effort
are helping physicians and patients across the country engage in conversations
about what care they need, and what we can do to reduce waste and overuse in our
Since the launch of the Choosing Wisely campaign in April 2012, 92 national and
state medical specialty societies, regional health collaborative organizations,
and consumer partners have joined this important conversation about appropriate
care. ASH's list is part of a third group of Choosing Wisely lists that have
been or will be released by more than 30 specialty societies between August 2013
and early 2014. Taken as a whole, these lists identify more than 250 tests and
procedures that physicians and patients should discuss before ordering.
The campaign continues to reach millions of consumers nationwide through a
stable of consumer and advocacy partners, led by Consumer Reports--the world's
largest independent product-testing organization--which has worked with the ABIM
Foundation to distribute patient-friendly resources for consumers and physicians
to engage in these important conversations.
To learn more about Choosing Wisely and to view the complete lists and
additional detail about the recommendations and evidence supporting them, visit
The American Society of Hematology (ASH) (www.hematology.org) is the world's
largest professional society of hematologists dedicated to furthering the
understanding, diagnosis, treatment, and prevention of disorders affecting the
blood. For more than 50 years, the Society has led the development of hematology
as a discipline by promoting research, patient care, education, training, and
advocacy in hematology. The official journal of ASH is Blood
(www.bloodjournal.org), the most cited peer-reviewed publication in the field,
which is available weekly in print and online.
About the ABIM Foundation
The mission of the ABIM Foundation is to advance medical professionalism to
improve the health care system. We achieve this by collaborating with physicians
and physician leaders, medical trainees, health care delivery systems, payers,
policy makers, consumer organizations and patients to foster a shared
understanding of professionalism and how they can adopt the tenets of
professionalism in practice. To learn more about the ABIM Foundation, visit
www.abimfoundation.org, read the ABIM blog blog.abimfoundation.org, or connect
with ABIM on Facebook and Twitter.
About Choosing Wisely(R)
First announced in December 2011, Choosing Wisely(R) is part of a multi-year
effort led by the ABIM Foundation to support and engage physicians in being
better stewards of finite health care resources. Participating specialty
societies are working with the ABIM Foundation and Consumer Reports to share the
lists widely with their members and convene discussions about the physician's
role in helping patients make wise choices. Learn more at
SOURCE American Society of Hematology