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Chapter 2
Consultative hematology
The role and effectiveness of the consultant
A hematology consultant provides expert advice about the diagnosis and management of benign or malignant hematologic disorders to requesting physicians and other health care providers. A consultation request might involve an adult general medical patient, a child or adolescent, a pregnant woman, a perioperative patient, or an individual who is critically ill. Given the relatively low numbers of physicians specifically trained in hematology, in some situations, a hematologist may also be asked to render an opinion on patient management to another physician, perhaps from a distance, without having directly seen the patient; requests such as these should be considered carefully
Consultation for surgery and invasive procedures
Preoperative assessment of bleeding risk Perioperative hemorrhage, hemostatic agents, and transfusion Intraoperative hemorrhage Hemostatic agents Transfusion Postoperative bleeding Thromboprophylaxis and postoperative thrombosis Prophylaxis for thromboembolism Treatment of postoperative deep vein thrombosis Excessive warfarin dosing
Intensive care unit
Anemia Thrombocytopenia Drug-induced thrombocytopenia Infection and DIC Massive transfusion-induced thrombocytopenia Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome Catastrophic antiphospholipid antibody syndrome
Consultation for hematologic complications of solid organ transplantation
Transfusion support Posttransplantation erythrocytosis Posttransplantation lymphoproliferative disorders Drug-related abnormalities Alloimmune complications
Pregnancy
Anemia Thrombocytopenia von Willebrand disease Thrombophilia and thromboembolism during pregnancy Thrombophilia, fetal loss, and poor pregnancy outcomes Artificial heart valves Hematologic malignancies
Selected outpatient hematology topics
Mild thrombocytopenia Leukocytosis Leukopenia Atypical lymphoproliferative processes Lymphadenopathy Persistent polyclonal lymphocytosis Castleman disease Splenomegaly
Consultation in pediatric patients
Anemia in the newborn Neutropenia in the newborn Thrombocytopenia in the newborn Coagulopathy in the newborn Thrombosis in the newborn Anemia in children ITP in children Lupus anticoagulants in children | ||||||||||||||||||||||||||||||||||||||||||||||||||