Don't Perform Repetitive Blood Counts, and Four Other 'Don'ts'

Zosia Chustecka

December 16, 2015

ORLANDO — Although ordering blood tests is as routine as morning coffee, one of the new Choosing Wisely recommendations suggests a halt to this practice.

"Don't perform repetitive complete blood counts and chemistry testing in the face of clinical and laboratory stability," is just one of the latest recommendations highlighted this year at the American Society of Hematology (ASH) 57th Annual Meeting. Taking blood for routine tests can quickly add up, mounting up to half a liter or more, and very sick patients cannot afford to be losing that much blood, especially if the tests are not providing any useful information, experts said here.

There were four other recommendations, for the most part also starting with the word "don't". But that's the idea behind the Choosing Wisely campaign, to cut down on unnecessary tests and practices. Launched in 2012 by the American Board of Internal Medicine, in subsequent years many different medical societies have come up with lists of recommendations relevant to their own specialty. ASH has already produced a set of five recommendations in 2013 and added on another set of five recommendations in 2014, as previously reported by Medscape Medical News.

This year, the ASH Choosing Wisely Task Force took a different approach, and decided to highlight recommendations that have been made by other societies that are of relevance to hematologists.

"We had some awareness of recommendations that were relevant," said Lisa Hicks, MD, from the University of Toronto, who has headed the ASH task force since it began. "Some were procedures that we had already highlighted ourselves through our previous searches of the literature but had chosen not to prioritize because we knew other societies were looking at them," she said in an interview. "We also thought it would be useful for our members to hear from other specialists, outside of hematology."

Dr Hicks and her 12 colleagues on the ASH Choosing Wisely Task Force began a systematic review of recommendations from other medical societies. In total, there were 380 recommendations from 65 societies. "We assessed them for medical relevance and importance," she explained, using guiding principles of harm avoidance, looking at the evidence base, aggregate cost, frequency, and also considering the relevance and impact on hematology specialists. Eventually, they whittled the list to five recommendations, which were unveiled at a special session during the meeting.

Choosing Wisely Recommendations for Hematologists
Don't image for suspected pulmonary embolism (PE) without moderate or high pretest probability of PE (from the American College of Radiology)
Don't routinely order thrombophilia testing on patients undergoing a routine infertility evaluation (from the American Society for Reproductive Medicine)
Don't perform repetitive complete blood count and chemistry testing in the face of clinical and lab stability (from the Society for Hospital Medicine – Adult Hospital Medicine)
Don't transfuse red blood cells for iron deficiency without hemodynamic instability (from the American Association of Blood Banks)
Avoid using 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)

American Society of Hematology (ASH) 57th Annual Meeting. Presented December 7, 2015.

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