Hematology and blood

MKSAP: 24-year-old woman with sickle cell anemia

January 21, 2017Jan 21, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman undergoes routine evaluation. She is pregnant at 12 weeks' gestation. Medical history is notable for homozygous sickle cell anemia (Hb SS).…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 24-year-old woman undergoes routine evaluation. She is pregnant at 12 weeks’ gestation. Medical history is notable for homozygous sickle cell anemia (Hb SS). She has had multiple uncomplicated painful crises treated at home with hydration, nonopioid analgesia, and incentive spirometry. She requires hospital management for these episodes approximately twice per year. She has declined …

J. Leonard Lichtenfeld, MD

How can hope help make cancer a chronic disease?

October 21, 2016Oct 21, 2016

Perhaps, doctors struggle more than most with memories that mark sad moments in their careers. For me, one of the most indelible was of a wonderful young man with chronic myeloid leukemia (CML). When I started my oncology career in…

Perhaps, doctors struggle more than most with memories that mark sad moments in their careers. For me, one of the most indelible was of a wonderful young man with chronic myeloid leukemia (CML).

When I started my oncology career in the early 1970s, CML was almost always fatal. It would start with a chronic phase, which was treated with pretty simple medications. But those medications didn’t cure the disease.

The “almost always” …

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MKSAP: 54-year-old man with low-risk myelodysplastic syndrome

October 15, 2016Oct 15, 2016

A 54-year-old man is evaluated during follow-up consultation regarding laboratory studies completed for a life insurance policy. He reports no symptoms. On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 131/76 mm Hg, pulse rate is 88/min,…

A 54-year-old man is evaluated during follow-up consultation regarding laboratory studies completed for a life insurance policy. He reports no symptoms.

On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 131/76 mm Hg, pulse rate is 88/min, and respiration rate is 15/min. No splenomegaly is noted.

Laboratory studies:

Hemoglobin 8.9 g/dL (89 g/L)
Leukocyte count 3000/µL (3.0 × 109/L) with 30% neutrophils, 10% monocytes, and 60% lymphocytes
Mean corpuscular volume 105 fL
Platelet count 75,000/µL …

Multiple choice questions are a terrible way to test doctors

Jeremy Gabrysch, MD

August 9, 2016Aug 9, 2016

Most people are surprised to hear that the way doctors are recertified every ten years is through a multiple choice test. “Really?” they’ll say. “You take a multiple choice test? As a doctor?” Unfortunately, after all these years that's the…

Unfortunately, after all these years that’s the most efficient way we can think of to evaluate professionals. But the method is so flawed. And your ability to answer questions on the multiple choice test isn’t necessarily linked with …

Dancing the anemia waltz. With a surprise ending.

James C. Salwitz, MD

May 14, 2016May 14, 2016

"If it walks like a duck and quacks like a duck, it is probably a duck. " At 62 years old, Roberta had been healthy. She walked three miles a day, stayed up late and enjoyed events with her three…

“If it walks like a duck and quacks like a duck, it is probably a duck. ”

At 62 years old, Roberta had been healthy. She walked three miles a day, stayed up late and enjoyed events with her three grandchildren. She had no history of significant surgery, and took only a single pill for blood pressure. The only health tragedy in her life was the death of her last child, an …

Should we be concerned about Hillary Clinton’s health?

Vamsi Aribindi, MD

April 14, 2016Apr 14, 2016

This presidential campaign has been alternately amusing and terrifying, courtesy of the antics of Donald Trump. The prospect of someone who feels the need to boast about the size of his penis during a presidential debate having his small, small…

He is looking increasingly likely to be nominated by the Republican Party. Many, however, …

Permission to take my patients’ plasma. It’s a harder decision than you think.

David Margolius, MD

April 6, 2016Apr 6, 2016

"I hereby authorize xxx, my patient, to donate plasma up to two times per week." I moved to Cleveland over the summer to start work as a full-time primary care internist. Within a few weeks, I started receiving a form…

“I hereby authorize xxx, my patient, to donate plasma up to two times per week.”

I moved to Cleveland over the summer to start work as a full-time primary care internist. Within a few weeks, I started receiving a form in my mailbox that I had never seen during my training in San Francisco: an authorization request for my patients to donate their plasma.

By the time the fourth form came, I realized …

MKSAP: 28-year-old woman with progressive dyspnea and fatigue

December 12, 2015Dec 12, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old woman is evaluated for a 1-week history of progressive dyspnea and fatigue. She was diagnosed with Hodgkin lymphoma 2 months ago and…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 28-year-old woman is evaluated for a 1-week history of progressive dyspnea and fatigue. She was diagnosed with Hodgkin lymphoma 2 months ago and is receiving chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). She takes no other medications.

On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 134/82 mm Hg, pulse rate …

Test your medicine knowledge: 48-year-old woman with fatigue

October 17, 2015Oct 17, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old woman is evaluated for fatigue and intermittent abdominal discomfort of 2 months' duration and occasional dark urine. Medical and family histories are…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 48-year-old woman is evaluated for fatigue and intermittent abdominal discomfort of 2 months’ duration and occasional dark urine. Medical and family histories are unremarkable. Her only medication is an oral contraceptive pill.

On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 125/74 mm Hg, pulse rate is 68/min, and respiration rate is …

Ellis Neufeld, MD, PhD & Stacy Croteau, MD

Patient autonomy is held to be sacrosanct. A doctor reconsiders this view.

Anonymous

September 26, 2015Sep 26, 2015

The refusal of blood products by the Jehovah’s witnesses has often been cited as a great example of patient religious freedom triumphing over the traditional paternalism of medicine. Patients are free to refuse transfusion even at the risk of death. Many hospital-based physicians have, at one time or another, been witness to the demise of a patient refusing blood products, perhaps a preventable demise. Patient autonomy is held to be …

Meds

Dose recommendations for extended half-life hemophilia factor products fall short

July 2, 2015Jul 2, 2015

We, like many in the hemophilia community, were excited to see extended half-life (EHL) factor VIII and IX products start coming to market over the last few months. These products — and expected future products — promise equivalent or greater prophylactic bleeding control with fewer infusions, and so could greatly enhance patients’ quality of life.

Yet, as we noted in our recent editorial in Haemophilia, we are greatly concerned that patients …

Being a bone marrow donor: This is what it’s like

Ashley Chambers, MD

June 18, 2015Jun 18, 2015

I enter through the sliding doors, my flip-flops slapping the linoleum as I search for the information desk. “Can you point me towards the apheresis center?” I ask, noticing my voice rise a notch. I am clearly uncomfortable. My feet feel naked and exposed without my Dansko clogs, and I can’t remember the last time I wore jeans in a hospital. Two medical students scurry by, their stethoscopes bouncing around …

5 things to know about what’s new in hemophilia

Ellis Neufeld, MD, PhD

March 17, 2015Mar 17, 2015

From new longer-acting drugs to promising gene therapy trials, much is changing in the treatment of hemophilia, the inherited bleeding disorder in which the blood does not clot. I will mark Hemophilia Awareness Month by discussing research and treatment progress,…

1. Many more treatment products are being introduced, including some that last longer. In people with hemophilia, a “factor” — or blood …