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Choosing Wisely Canada

Canadian Hematology Society - Canadian Medical Association - University of Toronto

The diagnosis of lymphoma requires specimens with intact cellular architecture for accurate histopathologic and immunophenotypic classification. FNA is associated with a low sensitivity and potentially results in delays in lymphoma diagnosis. Although excisional biopsy is the gold standard for lymphoma diagnosis, depending on the lymph node location, excisional biopsy may be associated with complications and the need for general anesthesia. At a minimum, an imaging-guided core biopsy should be ...

Choosing Wisely Canada

Canadian Hematology Society - Canadian Medical Association - University of Toronto

Early pregnancy losses are common amongst healthy women. Current guidelines do not support the routine screening of women with pregnancy loss for inherited thrombophilias. Moreover, there are recommendations against instituting thromboprophylaxis in women with inherited thrombophilias wishing to achieve a successful term pregnancy. By performing testing for inherited thrombophilias, patients may be unnecessarily exposed to the harms of thromboprophylaxis, inappropriately labeled with a ...

Choosing Wisely Canada

Canadian Hematology Society - Canadian Medical Association - University of Toronto

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Choosing Wisely Canada

Canadian Hematology Society - Canadian Medical Association - University of Toronto

Treatment for ITP is recommended for a platelet count less than 30×109/L. Corticosteroids are considered first-line treatment, with the addition of IVIgG reserved for severe ITP and bleeding, when a rapid rise in platelets is required, or when corticosteroids are contraindicated. There is no evidence of benefit of IVIgG in combination with corticosteroids for first-line treatment of asymptomatic ITP. Unnecessary IVIgG infusions can result in multiple adverse effects, including acute hemolytic ...

Choosing Wisely Canada

Canadian Association of Gastroenterology - Canadian Medical Association - University of Toronto

The risks of long term steroid therapy (therapy for more than 4 months and/or more than two courses in a year) outweigh any benefits in inflammatory bowel disease and should not be given to patients. Instead, they should be offered more effective maintenance therapy such as immunosuppression or biologic therapy that are safer and have more evidence for efficacy.