Requirement for a Pathologist's Second Signature Limits Inappropriate Inpatient Thrombophilia Testing.

Thromboembolism is a condition that leads to the hospitalization of thousands of patients in the United States annually. Recent guidelines suggest that testing for hereditary, acquired and combined forms of thrombophilia be delayed following hospitalization for a first-time acute thrombotic event. Instead, thrombophilia testing would be performed in an outpatient setting, at least 1 month after discontinuation of anticoagulant therapy or 3 months after the thrombotic event, on the understanding that anticoagulation may affect some testing.

The management of anticoagulation in patients undergoing therapeutic plasma exchange: A concise review.

We surveyed multiple apheresis centers represented by the authors for their clinical approach to the management of anticoagulation issues during therapeutic plasma exchange (TPE). We present the results of their practices and a review of the pertinent literature. As plasma is removed during TPE, replacement with all or partial non-plasma-containing fluids (eg, 5% albumin) may lead to significant changes in hemostasis.

Use of standard laboratory methods to obviate routine dithiothreitol treatment of blood samples with daratumumab interference.

Daratumumab is an antibody currently used in the treatment of patients with refractory multiple myeloma. Blood samples from patients being treated with daratumumab may show panreactivity during pre-transfusion testing. To facilitate the provision of blood components for such patients, it is recommended that a baseline phenotype or genotype be established prior to starting treatment with daratumumab.

Therapeutic plasma exchange and pregnancy: A case report and guidelines for performing plasma exchange in a pregnant patient.

Therapeutic plasma exchange (TPE) has been demonstrated to be of significant clinical value in a number of diseases and conditions, with well-established guidelines and recommendations. However, technical support in providing this procedure for pregnant patients is largely absent from these recommendations, leaving therapeutic apheresis practitioners without guidance to safely and adequately treat appropriate conditions in this important patient population. Here, we describe our experience in treating a 35-year-old pregnant patient with relapsing-remitting multiple sclerosis with TPE.

Sebastian syndrome with abnormal platelet response to ristocetin.

Background: Sebastian syndrome is characterized by enlarged platelets and Döhle-like body leukocyte inclusions. This syndrome is an MYH-9-related disease, a group that also includes May-Hegglin anomaly and Fechtner syndrome. The differential diagnosis of the MYH-9 diseases requires ultrastructural studies.

Pilot of a hospice-based elective to learn comfort with dying patients in undergraduate medical education.

Background: A majority of medical students feel uncomfortable with dying patients.

Objective: We designed a pilot program to train medical students to be hospice volunteers to determine (1) the value of contact with dying patients in changing medical students' comfort level and (2) the mechanics of starting such a course in cooperation with a nonacademic agency.

Design: Students were required to undergo hospice training provided by the local hospice.