Message from the Program Chair


SANDRA KURTIN

September 2021

SANDRA KURTIN, PhD, ANP-C, AOCN®

Nurse Practitioner
University of Arizona and University of Arizona Cancer Center

As many return to school this fall, we are reminded that as health care providers, we are challenged to engage in life-long learning to assimilate the constant advances in science and the resulting changes in recommendations for the diagnosis and management of illnesses relevant to our clinical practice, as well as disorders that may provide valuable insights into patient issues outside our scope of care.

JADPRO’s benign hematology program this month features compelling short videos in which faculty pair with a colleague or invited guest to highlight key concepts, current treatment, supportive care decisions, and patient education in the management of selected blood disorders.

For the Autoimmune Cytopenias pillar, David Hughes and Frances Blevins discuss in a video the current initial treatment and long-term management of chronic immune thrombocytopenia (ITP), along with dosing considerations and adverse drug events related to specific agents. Don’t miss David’s presentation on ITP at JADPRO Live Virtual, starting this October 7!

Natasha Johnson and Sara Tinsley describe the case of a 22-year-old male patient in their Bone Marrow Failure Disorders video, in their review of diagnosis and management of benign paroxysmal nocturnal hemoglobinuria (PNH). As Dr. Tinsley explains, PNH should be considered in younger patients with Coombs-negative hemolytic anemia and/or an unprovoked thrombosis.

The Hemoglobinopathies pillar video by Susan Carson and Anne Nord reviews the pathophysiology of sickle cell disease and its four subtypes, highlighting ways to address its acute and chronic complications and smooth the transition into adult care.

Jennifer Donkin, in the Hereditary/Acquired Bleeding Disorders video, interviews Michelle Witkop, Head of Research at the National Hemophilia Foundation (NHF). Dr. Witkop provides an overview of the NHF’s work; the Foundation’s resources for patients and advanced practitioners; and important trends in hemophilia research.

I hope you continue to find areas where these updates complement your ongoing education, and I welcome any comments you may have on the latest videos, news reports, and resources.

 

SANDRA KURTIN

August 2021

SANDRA KURTIN, PhD, ANP-C, AOCN®

Nurse Practitioner
University of Arizona and University of Arizona Cancer Center

This month, we are featuring exclusive video discussions in which faculty from each of the Class Categories partner with a colleague to highlight challenges and clinical pearls in the management of a specific blood disorder.

David Hughes and Frances Blevins review essential features of chronic immune thrombocytopenia (ITP), including common presenting symptoms, etiologies, and options for treatment in a video for the Autoimmune Cytopenias pillar.

In the Bone Marrow Failure Disorders video, Natasha Johnson and Sara Tinsley discuss the management of a 33-year-old male patient with no significant past medical history who presented with dyspnea, fatigue, easy bruising; he was found to be pancytopenic and was diagnosed with aplastic anemia.

The video for the Hemoglobinopathies pillar delves into beta-thalassemia in adult patients, with Susan Carson and Anne Nord providing important patient care tips, guidelines for referral, and strategies for management of iron overload.

Jennifer Donkin interviews her colleague Jacquelyn Keegan about essential tools and strategies for the care of women with bleeding disorders in a video for the Hereditary/Acquired Bleeding Disorders pillar. Ms. Keegan describes patient evaluation, education, and treatment in a specialty clinic for patients presenting with heavy menstrual bleeding, common in women with von Willebrand disease.

Besides the videos, we have of course posted more resources, updates from the medical literature, and news—including coverage of the International Society for Thrombosis and Haemostasis 2021 Congress, hosted from Philadelphia and held virtually from July 17 to 21. 

Enjoy the rest of your summer!

SANDRA KURTIN

July 2021

SANDRA KURTIN, PhD, ANP-C, AOCN®

Nurse Practitioner
University of Arizona and University of Arizona Cancer Center

We are pleased to offer more real-world case studies this month—one for each of the four Class Categories, to bring the content to life.

The Autoimmune Cytopenias case study highlights clinical pearls in the use of steroids and rituximab for warm autoimmune hemolytic anemia, plus tips for optimizing supportive care.

The Bone Marrow Failure Disorders case study describes development of a second bone marrow disorder in an older patient originally treated with anti-thymocyte globulin (ATG), cyclosporine (CSA), and eltrombopag for aplastic anemia (AA). Prior to receiving ATG/CSA, the patient had been passing dark urine in the morning and was experiencing severe joint and muscle pain. He was ultimately diagnosed with paroxysmal nocturnal hemoglobinuria (PNH). The pearl here is that PNH can occur in conjunction with other bone marrow disorders. While the PNH clone in AA may be near normal when first tested (due to the aplastic marrow), once normal hematopoiesis is restored following successful treatment of AA the clone can expand to cause some of the complications outlined in this case.

The case study for the Hemoglobinopathies pillar offers excellent tips for management of menorrhagia and secondary acute anemia in young women with sickle cell disease.

Finally, in Hereditary/Acquired Bleeding Disorders, the importance of multidisciplinary management is underscored in a discussion of compartment syndrome in a young man with severe hemophilia A. This case highlights the importance of comprehensive specialty care for patients with rare bleeding disorders.   

As always, please share this resource with your colleagues, and feel free to contact me with comments or suggestions. 

SANDRA KURTIN

June 2021

SANDRA KURTIN, PhD, ANP-C, AOCN®

Nurse Practitioner
University of Arizona and University of Arizona Cancer Center

I hope everyone is enjoying the start of summer and perhaps even taking a break from busy work schedules. I hope you will take a few minutes to look at the newest content on Benign Hematology Updates.

Our Benign Hematology Basics 101 videos provide an overview of common and rare disorders.

The Autoimmune Cytopenias pillar updates this month include a report describing I-WISh, a large international survey of treatment perceptions related to immune thrombocytopenia (ITP), and a comprehensive review of novel emerging therapies for ITP and CLL-associated autoimmune hemolytic anemia.

The Bone Marrow Failure Disorders pillar offers information about a mechanism underlying the pathogenesis of paroxysmal nocturnal hemoglobinuria (PNH); Marrowforums, a discussion and resource center for BMF patients and their healthcare providers; and the recent approval of the complement C3 inhibitor pegcetacoplan for treatment of PNH.

The Hemoglobinopathies pillar includes guidance on testing and follow-up to support early detection of hemoglobin disorders; and a study using a lifetime Markov model to assess the cost-effectiveness of a hypothetical cell or gene-therapy cure for sickle cell disease.

In Hereditary/Acquired Bleeding Disorders, recommendations to optimize testing for VWD during times of acute heavy menstrual bleeding and development of a risk score to predict high bleeding risk in low VWF patients are highlighted.

It’s an exciting time for patients with benign hematologic disorders, as new information about potential pathways and targets for treatment continues to emerge. Of course, connections to COVID-19 and hematologic malignancies still thread through the conversation. Please dive into the Benign Hematology Updates website. We will be adding new case studies and videos soon, so stay tuned!

SANDRA KURTIN

May 2021

SANDRA KURTIN, PhD, ANP-C, AOCN®

Nurse Practitioner
University of Arizona and University of Arizona Cancer Center

Greetings! I hope you’ve had an opportunity to explore JADPRO’s Benign Hematology Updates website, which launched in April. The site offers clinical pearls and learning opportunities in several formats, including important news and studies in the medical literature; useful resources and guidelines; and case studies and Fast Facts sheets that provide clinical snapshots of an array of benign hematologic disorders, with tips for management.

This month, we’re pleased to add video interviews that I conducted with the expert faculty editors for each of the four Class Categories: Jennifer Donkin offers “day in the life” insights into her work and resources for management of hemophilia and von Willebrand disease from childhood through adulthood; David Hughes and Frances Blevins discuss their collaboration in managing immune thrombocytopenia; Natasha Johnson highlights best practices in the management of paroxysmal nocturnal hemoglobinuria, or PNH; and Susan Carson focuses on what the advanced practitioner should keep front-of-mind when caring for patients with beta-thalassemia. A common theme in these videos is multidisciplinary management and coordination of care for patients with these often-chronic but rare disorders. 

As I noted in my welcome video, many of the disorders covered in this program are rare and less likely to be encountered in your clinical practice. However, I believe that information centered on the expanding and evolving management of benign hematologic disorders provides the advanced practitioner with myriad benefits—perhaps most notably a deepened understanding of how these disorders intersect with patient education and supportive care; malignant transformation; and, as we are learning, COVID-19.

Selected content is refreshed monthly, so please visit the Benign Hematology Updates website often and share the site with your colleagues. Take a moment to subscribe to the Journal of the Advanced Practitioner in Oncology (JADPRO) and join the Advanced Practitioner Society for Hematology and Oncology (APSHO) to get access to even more resources created expressly for advanced practitioners in oncology.

 

SANDRA KURTIN

April 2021

SANDRA KURTIN, PhD, ANP-C, AOCN®

Nurse Practitioner
University of Arizona and University of Arizona Cancer Center

Greetings, and welcome to JADPRO Benign Hematology Updates. I hope you will explore and engage with the full array of resources that we’ve developed for our advanced practitioner (AP) audience on management approaches to a broad range of disease states in the evolving field of benign blood disorders. APs play a critical role in the multidisciplinary care of these conditions—which can be inherited or acquired; chronic and mild or acute and life-threatening; are often rare; and may be challenging to diagnose. Comprehensive differential diagnosis is critical since the patients’ symptoms may be incorrectly attributed to inconsequential causes. These often-complex disorders may occur in conjunction with or as a result of cancer, and in some cases may transform into malignancies.

Complicating today’s management of benign hematologic disorders, of course, is the challenge of COVID-19, declared as a pandemic by the World Health Organization just a year ago, in March 2020. As we have learned, COVID-19 can manifest with acute vascular effects such as micro-occlusions, and “long haul” COVID survivors may experience key symptoms (such as chronic fatigue) that often manifest in our patients with blood disorders. Ongoing research and our own experience have shown that patients with inherited or acquired benign hematologic disorders are at increased risk of severe COVID-19. The impact of this emerging clinical challenge, which will likely continue in the near future even with ongoing rollout and uptake of the SARS-CoV-2 vaccine, will be explored in the current JADPRO Benign Hematology Updates program, which is planned to run through March 2022, with content refreshed regularly.

This comprehensive program is organized into four broad topic areas, each guided by a dedicated specialist or specialist team: Hereditary/Acquired Bleeding Disorders, led by Jennifer Donkin, PNP, DNP, from the Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles; Autoimmune Cytopenias, led by David Hughes, PharmD, BCOP, and Frances Blevins, PA-C, from Boston Medical Center; Hemoglobinopathies, led by Susan Carson, RN, MSN, CPNP, from the Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles; and Bone Marrow Failure Disorders, led by Natasha Johnson, MSN, APRN, AOCNP, from Moffitt Cancer Center.

This microsite offers a selection of important clinical studies and best-practice resources; my comprehensive Benign Hematology Basics presentation; Fast Facts, with essential information on current diagnosis, treatment, supportive care, and prognosis of selected benign blood disorders; case studies from practitioners working in a variety of clinical settings; and video discussions in which expert APs share their tips and perspectives on challenging aspects of care. The program faculty and I look forward to sharing our years of experience and practice pearls with you.

Learn more about our program launch, as well as other planned content for this special series, in my welcome video.

I look forward to sharing new content with you on a monthly basis, as we develop this expanding resource further. Please feel free to contact me via editor@advancedpractitioner.com with your comments and questions.