ASH News Daily 2012 - Saturday, December 8, 2012 - (Page A-16)
Page A–16
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ASH NEWS DAILY
Isn’t That Getting a Little Personal?
A collection of personal and
patient stories from the
ASH News Daily 2012
Editorial Board
BY MICHAEL R. BISHOP, MD
O
ne of my favorite things
to do when I meet a new
colleague or interview a
new faculty candidate is to ask
them what led them into the field
of hematology. I have found that
it is a relatively easy ice breaker,
but more importantly, it provides
me with some real insight into
who this person really is. I have
posed this same question to the
ASH News Daily Editorial Board
members, with whom I have had
the pleasure of getting to know
and work with over the past several
months. All of them have an
impressive list of academic credentials
and are great physicians,
but each one has a unique and
personal experience that has contributed
to his or her success and
motivates him or her daily, whether
it is a patient story that has been
with them over the years or interaction
with others in the field. I
thought the readers of ASH News
Daily would enjoy and appreciate,
as we all have our own stories of
why we love hematology.
Andy Leavitt – “As a Harvard
medical student I was fortunate to
obtain a Karin Grunebaum Foundation
fellowship to fund a year of
research, and I spent that year in the
Division of Pediatric Hematology/
Oncology at The Boston Children’s
Hospital. The division was directed
by David G. Nathan, MD, a fatherly
figure, and it was populated
by a large number of dynamic and
exciting young faculty.
I worked
most closely with Alan Schwartz,
MD, PhD, and Robert Garcia, MD,
where I studied the role of polyoma
virus coat proteins in cell transformation.
Aaron Ciechanover was at
that time working with Alan and
Harvey Lodish studying protein
degradation, and he would often be
in the lab. To me, he was just this big
fellow with a wonderful smile and
laugh. Little did I realize that he was
then laying the ground work for
and performing some of his seminal
studies in protein degradation that
led to his 2004 Nobel Prize in Chemistry.
The entire experience was so
positive, intellectually and interpersonally,
and it clearly cemented
my interest in hematology. To this
day, the thing that stood out the
most was the close and respectful
relationship among the laboratory
scientists, the clinicians, and the clinician
scientists, a sense of mutual
respect and community that I have
always attributed to the leadership
of David Nathan. So what did I
learn? Leadership matters. I am sure
that those experiences explain why
I feel so strongly about interacting
with medical students, encouraging
them, and exposing them to the excitement
of a career in hematology.”
Sanguine Saturday
BLEEDING
BY MARC J. KAHN, MD, MBA
T
emperament theory may have
its origins in Mesopotamia,
but it was popularized by Hippocrates
who believed that moods
and behaviors could be caused by
alterations in body fluids. One of the
temperaments,
sanguine,
derives
from the blood. Sanguine people
were thought to be impulsive, sociable,
charismatic, and boisterous.
Today’s Education Program ses-
sion on “Everyday Bleeding Disorders”
promises to be sanguine, or
at least evoke sanguinity among its
boisterous participants, as the presenters
discuss common bleeding
disorders and their management. As
sanguine individuals are creative,
the session should prove valuable
for those of us who are consulted
to evaluate patients with common
bleeding disorders.
The session on “Everyday Bleeding
Disorders” will be held in Room
A411-A412 from 7:30 to 9:00 a.m. in
the Georgia World Congress Center.
The session will be repeated in the
same room this afternoon from 2:00
to 3:30 p.m. Sarah H. O’Brien, MD,
MSc, from The Research Institute at
Nationwide Children’s Hospital in
Columbus, OH, will chair the session.
Dr. O’Brien, a pediatric hematologist,
has a particular interest in
the interaction between hematology
and women’s health. When reflecting
on the overall session, Dr.
O’Brien said, “The Everyday Bleeding
session truly offers something
for everyone. This eclectic group of
talks addresses diagnostic challenges
faced by both pediatric and adult
hematologists on a regular basis.
The audience will leave with a better
understanding of the strengths and
limitations of bleeding assessment
tools and laboratory testing in the
evaluation of patients with excessive
bleeding.”
In addition to chairing the session,
Dr. O’Brien will give the first talk,
titled “Bleeding Scores: Are They
Really Useful?” During this talk, Dr.
O’Brien will discuss the utility of the
Vicenza Bleeding Score and the Pediatric
Bleeding Questionnaire as they
relate to the diagnosis of von Willebrand
disease.
The second talk, “Making a Diagnosis
of von Willebrand Disease,”
will be given by Jorge DiPaola, MD,
of the Department of Pediatrics at the
University of Colorado. Dr. Di Paola
serves as associate professor in the
Departments of Pediatrics and Genetics
and has an interest in hemophilia
and other bleeding disorders. He will
discuss the molecular basis for von
Willebrand disease as it relates to diagnosis
and classification.
Pier M. Mannucci, MD, will give
the third talk in the session, “Hemostatic
Defects in Liver and Renal
Dysfunction.” Dr. Mannucci has
been a respected authority on hemostasis
and thrombosis for more than
30 years. He delivered the Ham-Wasserman
Lecture in 2002 and is the
chairman of Internal Medicine and
Medical Specialties at the University
of Milan. Today, Dr. Mannucci will
discuss medications and interventions
that can reduce bleeding in patients
with kidney and liver disease.
Today’s sessions on Everyday
Bleeding Disorders hope to educate,
inform, and advise regardless of temperament.
Even the most choleric,
melancholic, or phlegmatic among
us ought to benefit from this Education
session.
Dr. Kahn indicated no relevant conflicts
of interest.
Matt Hsieh – “I think what is
keeping me in hematology and clinical
research is my involvement with
transplant patients with sickle cell
disease. As you know, it is a disease
with very limited treatment options,
and caring for patients can be very
challenging. What has been very
eye-opening for me is the many faces
of sickle cell patients that I have
encountered, seeing them getting so
excited about the possibility of getting
a transplant to rid the disease,
and actually taking them through
that promising but, at times, difficult
transplant process.”
Jose Bufill – “Flo owned a beauty
shop in a small town in rural Indiana.
She loved what she did, so she
was very good at it. Her place was a
social hub. She was much admired
by her clients and esteemed by their
grateful husbands. So when she
complained of feeling really tired
all of the time, her family doctor listened.
Sure enough, her CBC was
abnormal. A macrocytic anemia and
a leucopenia were the reasons for
her referral. Seven years before, she
had an emergency partial gastrectomy
for a massive GI bleed, from
months of ingesting anti-inflammatory
medicines. Sure enough, when
her B12 level returned a few points
below normal, everything fell in to
place. SubQ injections of vitamin
B12 were started along with oral folic
acid supplements.
Needless to say, I was surprised
when two months later her CBC abnormalities
had not improved at all
and neither had her symptoms.
She agreed to a bone marrow
biopsy. She wanted to get better
and back to work. And sure
enough, the bone marrow demonstrated
a refractory anemia
with ringed sideroblasts. Cytogenetics
and a FISH MDS panel
were normal. Erythropoietin and
pyridoxine supplements were
begun. She didn’t miss a dose.
When she returned two months
later, her hemoglobin was 12,
but the leucopenia persisted and
now she was exhausted. She also
began to notice numbness in her
hands and feet. She couldn’t grip
those brushes and curling irons
well enough. She admitted that
maybe her fingertips had started
feeling numb a few months before.
Something was wrong. A
PubMed search for “sideroblastic
anemia and neuropathy” offered
a clue: an article – published
seven months before her referral
– describing cytopenias and
neuropathy in three patients with
a zinc-induced copper deficiency.
Could Flo be a fourth case? Sure
enough, her plasma zinc levels
were off the chart and copper
level returned at 50 (normal > 510
micrograms/L). For a year prior
to her presentation, Flo had been
taking 30 mg of zinc daily in a
popular local health tonic. She immediately
stopped the tonic and
started oral copper replacement.
»» PERSONAL Page A-18
Saturday, December 8, 2012
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