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(Not So) Benign Hematology Calls That Go Bump in the Night

December 9, 2023
Hilary Whitworth, MD, MSCE (@HilaryWhitworth)
Division of Hematology, Children’s Hospital of Philadelphia, Philadelphia, PA

We have all had that call from the ICU that makes our stomach drop. One of those dreaded diseases you know is going to be hard to treat and makes everyone anxious. Or maybe the call is for a patient population you don’t typically care for, like a pregnant patient or a child or young adult. Wouldn’t it be helpful to have advice from world experts on the most up-to-date evidence and guidance for clinical management? Well, you’re in luck! The Education Program on classical hematology this year is full of opportunities to prepare for those scary hematology calls. With 15 options (yes, 15!) specifically focused on classical hematology topics and offered Saturday through Monday, there is sure to be a topic and available time worthy of your attendance.  

Let’s start with thrombotic microangiopathy (TMA). Shruti Chaturvedi, MBBS, is chairing the session Why Am I Getting Paged at 2AM? Microangiopathic Emergencies (Saturday, 4:00 p.m. – 5:15 p.m., Convention Center, Room 29). Ever needed help with HELLP? Jennifer Jury McIntosh, DO, will discuss this diagnosis (i.e., hemolysis, elevated liver enzymes, and low platelets) and other microangiopathies that present in the context of pregnancy in her talk “Labor and Delivery: DIC, HELLP, Pre-eclampsia.” We know that time to diagnosis and treatment is critical in patients with microangiopathies. To this end, Dr. Chaturvedi will discuss the diagnosis and emergent treatment of patients with thrombotic thrombocytopenic purpura and other TMA processes in her talk “Medical Consult—aHUS, TTP—How to Distinguish and What to Do”. Finally, Beverley Hunt, MD, will provide some support for those challenging consults addressing coagulopathy in a critically ill patient. In her talk, “Consumptive Coagulopathy in the ICU”. Dr. Hunt will review the most contemporary data on the diagnosis and management of disseminated intravascular coagulation (DIC) and other consumptive etiologies such as extracorporeal circuits. Dr. Chaturvedi hopes this session will attract a broad audience who will consult on these sick patients with conditions that “require rapid and thorough clinical and laboratory evaluation to arrive at the appropriate diagnosis quickly to avoid death or significant morbidity.”  

Just the mention of “pediatric hematology” is scary enough to some that they won’t dare say the words five times to the mirror. Breathe easy, and let those of us who do this every day demystify the care of tiny humans (no, they are not just little adults, even when they have similar diseases). Nicole Kucine, MD, MS, is chairing the Education Program Session Alphabet Soup – Challenging Consults on the Pediatric Units (Monday, 4:30 p.m. – 5:45 p.m., Convention Center, Room 11). The session will focus on three-letter-word consults (TAM, HIT, DIC, HLH) that may evoke four-letter-word responses. Ashish Kumar, MD, will review hemophagocytic lymphohistiocytosis (HLH), including new diagnostic methods. Dr. Kucine will discuss the differential diagnosis for leukocytosis in children, including transient abnormal myelopoiesis (TAM) and juvenile myelomonocytic leukemia (JMML). Finally, Clifford M. Takemoto, MD, will present the differential for thrombocytopenic conditions, including heparin-induced thrombocytopenia (HIT), DIC, and TTP. Dr. Kucine and colleagues designed this session largely for clinicians, saying it is geared for “trainees, junior faculty, and anyone who wants some refreshers and to learn recent updates in some challenging consultative areas … and might even appeal to adult hematologists who want to hear a pediatric perspective.” She underscored the importance of this session focusing on “conditions where knowing how to get the right diagnosis and knowing who to treat is critical early on.”  

If alphabet soup is not your gig and/or you are looking to order outside of the “kids menu,” Hematologists as Lifesavers: Inpatient Hematology Emergencies will cover similar topics in adults (Monday, 4:30 p.m. – 5:45 p.m., Marriott Marquis, Grand Ballroom 5-6).  

What is more emergent than the issues that lie directly at the interface between health and social justice? Sessions focusing on long-term crises such as the blood donor supply and premature mortality in sickle cell disease promise to deliver an impactful perspective on topics that are at the forefront of equity and equality. The sessions are, respectively, Hot Topics in Blood Donation: Donor Risks and Social Justice (Sunday, 4:30 p.m. – 5:45 p.m., Convention Center, Hall A) and Improving Outcomes for Individuals with Sickle Cell Disease: Are We Moving the Needle? (Monday, December 11, 4:30 p.m. – 5:45 p.m., Convention Center, Room 29).  

No matter your background or level of expertise — whether you are a third-year fellow, a new attending, or the senior person on a team for the first time; a student who wants to hear firsthand how patients are diagnosed and managed in real life; or a researcher looking to translate science into clinical care — the Education Program Sessions are guaranteed to leave long-lasting impressions!  



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