PB1027 - Consultative Thrombosis and Hemostasis: The Impact of Hematological Evaluation in Hospitalized Patients

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

GL

Giselle G. Lima

MD, Department of Hematology Hemotherapy and Cellular Therapy
Hospital das Clinicas of University of São Paulo Medical School (HCFMUSP), São Paulo, Brazil
São Paulo, Sao Paulo, Brazil

Presenting Author(s)

Gabrielle de Mello Santos

MD
Department of Hematology, Hemotherapy and Cellular Therapy, Hospital das Clínicas of University of São Paulo Medical School (HCFMUSP), São Paulo, Brazil
Rio de Janeiro, Rio de Janeiro, Brazil

Co-Author(s)

FP

Fernando Guimaraes Porto

MD
Department of Hematology, Hemotherapy and Cellular Therapy, Hospital das Clinicas of University of São Paulo Medical School (HCFMUSP)
São Paulo, Sao Paulo, Brazil
CR

Cynthia Rothschild

MD
Department of Hematology, Hemotherapy and Cellular Therapy, Hospital das Clínicas of University of São Paulo Medical School (HCFMUSP), São Paulo, Brazil
São Paulo, Sao Paulo, Brazil
BS

Bianca Stefanello

MD
Department of Hematology, Hemotherapy and Cellular Therapy, Hospital das Clínicas of University of São Paulo Medical School (HCFMUSP), São Paulo, Brazil
São Paulo, Sao Paulo, Brazil
PP

Paula Prestes

MD, Department of Hematology Hemotherapy and Cellular Therapy
Hospital das Clinicas of University of São Paulo Medical School (HCFMUSP), São Paulo, Brazil
São Paulo, Sao Paulo, Brazil
TR

Tania Rubia Flores da Rocha

Pharmaceutical
Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, São Paulo, Brazil
São Paulo, Sao Paulo, Brazil
VR

Vanderson Rocha

MD
Department of Hematology, Hemotherapy and Cellular Therapy, Hospital das Clínicas of University of São Paulo Medical School (HCFMUSP), São Paulo, Brazil
São Paulo, Sao Paulo, Brazil
PV

Paula Villaça

Hematologist
Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, São Paulo, Brazil
São Paulo, Sao Paulo, Brazil
FO

Fernanda Andrade Orsi

MD
Department of Hematology, Hemotherapy and Cellular Therapy, Hospital das Clínicas of University of São Paulo Medical School (HCFMUSP), São Paulo, Brazil
São Paulo, Sao Paulo, Brazil

Background: Given the increasing specialization in hospital care and the ubiquity of hemostasis across all medical fields, analyzing the impact of specialty guidance becomes crucial to improve the quality of hemostasis consultations and patient care.

Aims: To analyze the requests for in-hospital consultation with Hemostasis and their potential impact on patient diagnosis and treatment.

Methods: Retrospective observational study including all consultation requests to the Hemostasis/Hematology Department at the HCFMUSP from January to December 2022. The origin of consultations, reasons for request, comorbidity, whether the diagnosis was hematological, and indication for treatment were evaluated.

Results: Of the 292 consultations, the primary reasons for requests were thrombocytopenia (40%), thrombosis and anticoagulation management (37.6%), and bleeding disorders (17.8%). Overall, a hemostasis consultation resulted in a hematologic diagnosis in 32% of consultations and guided treatment in 80% of consultations. For thrombocytopenia, the most commonly ordered tests were complete blood count (CBC) test and peripheral blood smear (80%), followed by renal and liver function assays and serology (30-50%). Secondary thrombocytopenia was the most common diagnosis and was managed by transfusion, control of underlying disease, and immunosuppression. Rare conditions included heparin-induced thrombocytopenia (5.4%) and thrombotic thrombocytopenic purpura (3.4%). For thrombosis, thrombophilia testing was recommended in 37.7% of cases, while no further testing was suggested in 26.4%. Most thrombotic events (85.5%) had no hematologic cause; antiphospholipid syndrome and familial thrombophilia were identified in 10% and 2% of these consultations, respectively. For bleeding disorders, the most common tests were CBC and coagulation screening. Hematologic causes were identified in 54% of these consultations and included hemophilia (21.2%), platelet disorders (11.5%), and von Willebrand disease (9.6%). Treatment recommendations included factor replacement, transfusion, DDAVP, and antifibrinolytics.

Conclusion(s): The prevalence of secondary diagnoses underscores the importance of Hemostasis and Thrombosis in various clinical settings. Nevertheless, hemostasis consultation played a crucial role in guiding both diagnoses and therapy.