Toward a Consensus on Centralization in Surgery.

Objectives: To critically assess centralization policies for highly specialized surgeries in Europe and North America and propose recommendations.

Background/methods: Most countries are increasingly forced to maintain quality medicine at a reasonable cost. An all-inclusive perspective, including health care providers, payers, society as a whole and patients, has ubiquitously failed, arguably for different reasons in environments.

Finding the elusive and causative autoantibody: An atypical case of autoimmune hemolytic anemia.

An isolated IgA-mediated autoimmune hemolytic anemia can present a diagnostic challenge. When a routine direct antiglobulin test (DAT) is negative but clinical suspicion remains high, further testing with monospecific antisera should be performed. As with IgG-mediated WAIHA, steroids are first-line treatment, though splenectomy is often required to achieve a durable treatment response.