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ASH Choosing Wisely Impacts Clinical Laboratories

As I mentioned in the blog posted on November 17, 2013, the American Board of Internal Medicine Foundation has started the Choosing Wisely Campaign in which each medical society has been asked to publish a list of 5 practices that physicians and patients should question. A recent editorial in New England Journal of Medicine opined that most specialties to date have listed only low impact items and have named other specialties services as low-value. Most have failed to include any major procedures that might significantly effect their income (NEJM 2014;370 (7):589). The fear is that payers may begin to use these lists to determine coverage, payment and utilization management decisions.

With this observation in mind it is interesting that three of the five items recently published by the American Society of Hematology (ASH) impact the clinical laboratory (Blood 2013;122:387-83). The three items are:

  • Do not transfuse more than minimum number of RBCs necessary to relieve symptoms of anemia or to return hemoglobin to a safe range of 7 to 8 g/dL in noncardiac patients
  • Do not test for thrombophilia in adult patients with VTE occurring in the setting of major transient risk factors such as surgery, trauma, or immobility
  • Do not administer plasma or prothrombin complex concentrates for nonemergent reversal of vitamin K antagonists. 

Although I agree with all three of these recommendations, I suspect they will have a much bigger impact on clinical laboratories and pathologists than on hematologists. 


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