Blood, Sweat and Smears - "ASH, 1 Question to Physicians"

Podcast Date: December 20, 2024
Host: Dr. Brad Lewis, Machaon Diagnostics

Overview

In this special episode, Dr. Brad Lewis shares insights from the American Society of Hematology (ASH) conference held in San Diego. The focus: one key question posed to visiting physicians—"What is the most critical test you order for your patients?" The episode compiles an array of answers from pediatric and adult hematologists, highlighting both essential and advanced diagnostic tests in the field of thrombosis and hemostasis.

Key Discussion Points and Insights

1. ASH 2024 Highlights ([00:30])

• Dr. Lewis expresses enthusiasm for the vibrant ASH meeting and notes the popularity of fun, educational stickers offered by Machaon Diagnostics.
• Quote:
  "This is just such a great meeting where things just seem to happen, even for benign hematology."
  — Dr. Brad Lewis [00:32]

2. The Question to Physicians: Critical Tests in Practice

Dr. Lewis introduces the core segment: interviews with conference-attending physicians about their go-to, most critical laboratory tests.

A. The Peripheral Blood Smear

A classic, widely valued diagnostic tool.

• Dr. Anthony Nguyen (UC San Diego):
  "The most critical test I order is a peripheral blood smear." [00:47]
• Dr. Kelly Davidson (University of Virginia):
  "The most critical test that I order is a peripheral blood smear that I review on my very old microscope in my office." [03:46]
• Dr. H:
  "The most critical test is a CBC with smear." [01:38]

B. Complete Blood Count (CBC) and Related Tests

CBC is frequently cited as the foundational test.

• Jackson (Riley Children's Health):
  "A CBC and retic together." [01:31]
• Dr. Leora Asholtz (Stanford):
  "The most critical test I run on my patients is, hands down, a cbc." [02:28]
• Dr. Robert Diep (Stanford):
  "My most critical test is a cbc." [02:45]
• Dr. Samahar Sukar (Alberta Children's Hospital):
  "The most critical test I order for a patient is just starting with the basic and order a cbc." [02:53]
• Dr. Jen Lighting (Johns Hopkins All Children's):
  "My most important test to order for my patients is cbc." [02:59]
• Dr. Michael Cole (Johns Hopkins):
  "Probably the most critical test I order is just a hemoglobin cause nothing will kill you faster." [03:10]
• Marina Beltrami (Ohio State University):
  "The most critical test that I order is the reticulocyte count." [03:33]

C. Specialty and Advanced Testing

Demonstrating the importance of tailoring diagnostics to patient context.

• Dr. Amanda Sara (Riley Children's Health):
  "The most critical test I order is flow cytometry." [01:26]
• Dr. Carol Lynn (Children's Hospital of Orange County):
  "The most important test that I like to send for my patients is the HLH genetic panel." [01:43]
• Dr. Stephanie Ambrose (Prisma Help Midlands):
  "The two most critical tests that I order would be Adam's TS13 testing and HLH testing with the soluble IL2 markers." [01:51]
• Dr. Kevin McNerney (Lurie Children's Hospital):
  "The most crit test I order is HLA typing." [02:16]
• Dr. Thomas Pfeiffer (Washington University):
  "The most critical test I order is flow based MRD after transplant." [02:39]

Memorable Moments & Notable Quotes

• "The most critical test I order is just a hemoglobin, cause nothing will kill you faster."
  — Dr. Michael Cole (Johns Hopkins University) [03:10]

• The affection for foundational techniques in the hematology community is echoed in Dr. Davidson’s attention to detail:
  "A peripheral blood smear that I review on my very old microscope in my office." [03:46]

• Several physicians emphasized simplicity and clinical fundamentals, reinforcing the importance of basic lab tests in saving lives.

Timestamps for Important Segments

• ASH Meeting Introduction & Stickers: 00:30
• First Physician Response (Dr. Anthony Nguyen): 00:47
• Key Responses from Different Physicians: 01:23 – 03:53
• Thanks to Participants and Wrap-Up: 03:53

Episode Tone and Language

The tone is collegial, appreciative, and pragmatic. Dr. Lewis and all contributors use concise, direct language, emphasizing how even the most essential tests remain central to patient care, while recognizing the significance of advanced diagnostics for specific cases.

Conclusion

This unique episode provides a valuable snapshot of what experienced hematologists consider most vital in the laboratory toolkit—ranging from the fundamental CBC and blood smear to advanced genetic and immunologic testing. The collective answers reinforce that, despite rapid technological advancements, foundational lab tests maintain their crucial status in diagnosing and managing blood disorders.