American Society of Hematology-American Society of Pediatric Hematology/Oncology

View all recommendations from this society

Released December 9, 2019

Don’t perform routine pre-operative hemostatic testing (PT, aPTT) in an otherwise healthy child with no prior personal or family history of bleeding.

Preoperative hemostatic screening in healthy pediatric patients with no personal or family history of excessive bleeding does not effectively identify those who will have unexpected surgical bleeding. Artifacts or disorders that do not affect bleeding risk may be identified, such as factor XII deficiency or an infection-associated, transient lupus anticoagulant.  Hemostatic testing adds cost and may introduce additional stress, either due to blood sampling or if a child has “abnormal” results.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Society of Hematology (ASH) and the American Society of Pediatric Hematology/Oncology (ASPHO) formed a task force to solicit, evaluate, and select list items for a pediatric focused Choosing Wisely list.  The panel was composed of 13 members – two co-chairs (representing ASH and ASPHO), five members selected by each organization, and one member serving as an advisor on Choosing Wisely methodology.  Suggestions were solicited from the membership of both societies.  Formal systematic reviews of the evidence were completed for eight semi-finalist items.  Final item selections were made by the ASH-ASPHO CW task force with reference to the following six guiding principles: avoiding harm to patients, producing evidence-based recommendations, considering both the cost and frequency of tests and treatments, making recommendations in the clinical purview of the hematologist, and considering the potential impact of recommendations. Harm avoidance was established as the campaign’s preeminent guiding principle.


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