ABIM Hematology cheat sheet

Bone marrow aspirate and biopsy: aspirate assesses cellular morphology and iron stores; biopsy assesses cellularity, fibrosis, and infiltration; both are usually obtained together from the posterior superior iliac spine.

Lumbar puncture in suspected CNS involvement: send cell count with differential, protein, glucose, cytology, and flow cytometry; traumatic tap correction uses expected WBC of 1 per 700 RBCs.

Intrathecal chemotherapy is indicated for CNS prophylaxis in high-risk ALL and for CNS relapse; common agents are methotrexate, cytarabine, and hydrocortisone.

Transfusion thresholds: restrictive strategy (hemoglobin 7-8 g/dL) is noninferior to liberal in most stable hospitalized adults; single-unit then reassess is standard.

Platelet transfusion prophylaxis is generally given below 10,000/microL; threshold rises to 20,000/microL for procedures such as central line placement and to 50,000/microL for major surgery or lumbar puncture.

Leukoreduction reduces febrile nonhemolytic reactions and alloimmunization; irradiated products are required for Hodgkin lymphoma, aplastic anemia, and intrauterine or neonatal transfusion to prevent transfusion-associated graft-versus-host disease.

Before starting cytotoxic chemotherapy, verify central venous access need, tumor lysis risk, fertility counseling, hepatitis B serologies, and cardiac ejection fraction when anthracyclines are planned.

Iron deficiency: low ferritin (<30 ng/mL) is diagnostic; ferritin 30-100 ng/mL with inflammation requires transferrin saturation (<20% supports deficiency).

Anemia of chronic disease: low serum iron, low TIBC, normal-to-high ferritin, low transferrin saturation, and normocytic or microcytic indices.

CML is defined by t(9;22) BCR-ABL1; first-line therapy is a tyrosine kinase inhibitor (imatinib, dasatinib, nilotinib), with response monitored by quantitative BCR-ABL1 transcript levels.

Acute promyelocytic leukemia is defined by t(15;17) PML-RARA; it is treated with all-trans retinoic acid plus arsenic trioxide, and coagulopathy is managed with aggressive platelet and fibrinogen support.

Multiple myeloma diagnostic criteria require clonal plasma cells ≥10% or biopsy-proven plasmacytoma plus CRAB features or a myeloma-defining event (≥60% plasma cells, involved/uninvolved free light chain ratio ≥100, or >1 MRI lesion).

Heparin-induced thrombocytopenia: 4T score risk-stratifies; treatment is immediate discontinuation of heparin and a non-heparin anticoagulant such as argatroban, bivalirudin, or fondaparinux.

Microangiopathic hemolytic anemia with schistocytes, thrombocytopenia, elevated LDH, and negative Coombs suggests TTP; ADAMTS13 activity <10% confirms and plasma exchange is initiated urgently.

Sickle cell disease acute chest syndrome: treat with oxygen, antibiotics, bronchodilators, incentive spirometry, and simple or exchange transfusion targeting hemoglobin near 10 g/dL.

Quality metrics in transfusion medicine include single-unit ordering rates, appropriate-use audits against evidence-based thresholds, and hemovigilance reporting of reactions.

Venous thromboembolism prophylaxis compliance, anticoagulation reversal time for intracranial hemorrhage, and door-to-needle intervals are measurable inpatient hematology quality indicators.

Morbidity and mortality conference review of chemotherapy-related deaths and anticoagulation-related bleeding yields systems-level process changes.

Registry participation (e.g., disease-specific leukemia or myeloma registries) supports benchmarking of survival and treatment-related mortality against peer institutions.

Clinical trials enrollment rates and time from eligibility identification to consent are trackable measures of care delivery in malignant hematology.

Transfusion reaction analysis should distinguish clerical error (most common cause of acute hemolytic reactions) from immune-mediated and nonimmune mechanisms to guide corrective action.

Maintenance of certification requires documented self-assessment and practice improvement activity; hematology-specific pathways include anticoagulation stewardship and chemotherapy safety modules.

Informed consent for chemotherapy must disclose intent (curative versus palliative), expected benefit, common and serious toxicities, alternatives including no treatment, and fertility implications.

Serious-news conversations follow a structured framework: prepare, assess understanding, deliver information in plain language, respond to emotion with empathy, and summarize next steps.

Bad-prognosis discussions should elicit patient values and goals before recommending a treatment plan; documented goals-of-care conversations reduce unwanted aggressive end-of-life care.

Interpreters are required for limited-English-proficiency patients; family members, especially minors, should not serve as medical interpreters.

Handoffs in hematology require explicit mention of anticoagulation status, recent transfusions, neutropenia and isolation status, and pending blood bank crossmatches.

Discussing sickle cell pain should avoid stigmatizing language; validate reported pain, agree on an analgesic plan, and document a written care plan to reduce emergency visits.

Conflicts of interest with industry (consulting, speaking, gifts, meals) must be disclosed and managed; federal Sunshine Act reporting requires public reporting of transfers of value.

Physician-patient confidentiality applies to genetic and hematologic diagnoses; disclosure of a heritable disorder to at-risk relatives generally requires patient permission.

Stewardship of scarce blood products and of costly therapies (e.g., CAR-T, gene therapy) is an ethical obligation balancing individual benefit and system resources.

Impaired colleagues and unsafe clinical performance should be reported through institutional channels; peer review protections vary by state.

Research ethics: institutional review board approval and informed consent are required for human subjects research; equipoise and risk minimization are core principles.

Documentation must be accurate and contemporaneous; altering records after the fact, including to reflect orders not given, is fraudulent.

Anticoagulation stewardship programs reduce bleeding and cost by standardizing indication, agent selection, monitoring, and reversal protocols.

Hospital transfusion committees oversee blood utilization, reaction reporting, and blood bank policy; restrictive transfusion protocols are a common cost- and safety-improving intervention.

Outpatient hematology infusion centers require capacity planning for chair time, pharmacy turnaround, and emergency response capability for hypersensitivity reactions.

Specialty pharmacy and prior authorization workflows delay oral targeted agents; tracking approval turnaround is a measurable system metric.

Sickle cell disease care benefits from a medical home model with a dedicated hematologist, pain plan, and coordinated emergency department protocols.

Apheresis and stem cell transplant programs require accreditation (e.g., FACT) and network participation for unrelated donor search through registries.

Value-based payment increasingly ties hematology reimbursement to emergency department utilization, hospital readmission, and adherence to oral anticoagulants or tyrosine kinase inhibitors.