ASH Releases Second List of Five Tests and Treatments to Question in Hematology

List highlights potentially unnecessary, sometimes harmful practices as part of Choosing Wisely® campaign

(WASHINGTON, December 3, 2014) – The American Society of Hematology (ASH), the world’s largest professional organization dedicated to the causes and treatments of blood disorders, today named five additional commonly used tests, treatments, and procedures in hematology that might not always be necessary. The additional items join an initial list of five practices to question that the Society released last year as part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation that aims to prompt conversations between patients and physicians about the necessity and potential harm of certain procedures. These new practices to question are also highlighted in a manuscript published this week in Blood, the Journal of the American Society of Hematology, which further describes the evidentiary basis of the recommendations.

ASH’s new Choosing Wisely recommendations (available at include:

  • Don’t treat with an anticoagulant for more than three months in a patient with a first venous thromboembolism occurring in the setting of a major transient risk factor.
  • Don’t routinely transfuse patients with sickle cell disease for chronic anemia or uncomplicated pain crisis without an appropriate clinical indication.
  • Don’t perform baseline or routine surveillance computed tomography (CT) scans in patients with asymptomatic, early stage chronic lymphocytic leukemia.
  • Don’t test or treat for suspected heparin-induced thrombocytopenia (HIT) in patients with a low pre-test probability of HIT.
  • Don’t treat patients with immune thrombocytopenic purpura in the absence of bleeding or a very low platelet count.

The second ASH Choosing Wisely list was developed after months of careful data analysis and review as well as input from the ASH membership, using the most current evidence about management and treatment options, with the goal of starting a conversation both within the hematology community and among physicians and their patients about quality of care.

“Unnecessary treatments or tests not only pose harm to individuals, but they also add waste to the health-care system, making it less efficient and effective for all patients,” said Lisa Hicks, MD, of St. Michael’s Hospital and the University of Toronto and chair of the ASH Choosing Wisely Task Force. “ASH developed its second Choosing Wisely list to ensure that hematologists better manage the utilization and delivery of patient-care resources, and the Society encourages hematologists to consider these recommendations in all facets of their work.”

The dominant guiding principle for ASH’s list and the rigorous selection process for list items is the concept of avoiding harm. The five other established guiding principles of the Choosing Wisely campaign are evidence, cost, frequency, scope of practice, and potential impact. With potential for patient harm as the leading principle under consideration, those tests, procedures, or treatments deemed as increasing risk of harm were prioritized for inclusion on ASH’s second Choosing Wisely list.

“Choosing Wisely set out to stimulate conversations about waste and overuse in our health care system. We’ve been fortunate to be joined in this effort by many dedicated partners—including ASH—who have committed to addressing unnecessary care in their specialty,” said Richard J. Baron, MD, President and CEO of the ABIM Foundation. “ASH’s second Choosing Wisely list gives clinicians and patients a new and important tool to help inform their conversations about what care is best for the patient.”

Since the launch of the Choosing Wisely campaign in April 2012, more than 100 national and state medical specialty societies, regional health collaborative organizations, and consumer partners have joined this important conversation about appropriate care. The campaign has reached millions of consumers through an initiative with Consumer Reports—the world’s largest independent product-testing organization—aimed at developing and distributing patient-friendly resources to help spark important conversations between physicians and patients.

To learn more about Choosing Wisely and to view ASH’s ten items to question, visit

Contact: Amanda Szabo, American Society of Hematology; 202-552-4914;


Editor’s Note: ASH Choosing Wisely Task Force Chair Dr. Lisa Hicks and select ASH members who assisted with the compilation of ASH’s Choosing Wisely list will discuss this initiative during a session at the 2014 ASH Annual Meeting in San Francisco.  

About ASH:

The American Society of Hematology (ASH) ( is the world’s largest professional society of hematologists dedicated to furthering the understanding, diagnosis, treatment, and prevention of disorders affecting the blood. For more than 50 years, the Society has led the development of hematology as a discipline by promoting research, patient care, education, training, and advocacy in hematology. The official journal of ASH is Blood (, the most cited peer-reviewed publication in the field, which is available weekly in print and online.

About the ABIM Foundation

The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit, read the ABIM blog, or connect with ABIM on Facebook and Twitter.

About Choosing Wisely®

First announced in December 2011, Choosing Wisely® is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. Participating specialty societies are working with the ABIM Foundation and Consumer Reports to share the lists widely with their members and convene discussions about the physician’s role in helping patients make wise choices. Learn more at