ASH News Daily 2012 - Saturday, December 8, 2012 - (Page A-16)

Page A–16 ® 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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ASH News Daily 2012 - Saturday, December 8, 2012

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