UNC hematologist Alice Ma, MD, part of the Choosing Wisely task force

Alice Ma, MD, from the UNC Division of Hematology/Oncology, was on the Choosing Wisely task force for the American Society of Hematology (ASH). ASH recently released a list of the five most common hematologic tests, treatments, and procedures that should be questioned by patients and physicians.

The American Society of Hematology (ASH), the world's largest professional organization dedicated to the causes and treatments of blood disorders, has released a list of common hematology tests, treatments, and procedures that are not always necessary as part of Choosing Wisely, an initiative of the ABIM Foundation. 

"Patients may sometimes request tests that may not be indicated, and physicians may recommend procedures that are also of limited value, and this list is designed to empower patients and physicians to be better consumers of health care," said Dr. Ma.  "It is not designed to limit health care, but to help patients and providers choose the best health care at the best time."

The list, also highlighted in a manuscript published online 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 question:

  • 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, noncardiac inpatients). 
  • Don't test for thrombophilia in adult patients with venous thromboembolism (VTD) 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 emergent surgery).

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.