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Update in Hematology
- Scott H. Goodnight, MD; and
- Donald I. Feinstein, MD
- From Oregon Health Sciences University, Portland, Oregon; and University of Southern California School of Medicine, Los Angeles, California. Requests for Reprints: Scott H. Goodnight, MD, Oregon Health Sciences University, 3181 Southwest Sam Jackson Park Road, L-471, Portland, OR 97201-3098. Current Author Addresses: Dr. Goodnight: Oregon Health Sciences University, 3181 Southwest Sam Jackson Park Road, L-471, Portland, OR 97201-3098.
Recent advances in hematology have focused on thromboembolic diseases and common anemias. Home-based delivery of low-molecular-weight heparin has become more common, and we have gained insight into the natural history of and risks for spontaneous venous thromboembolic disease. Pernicious anemia, previously believed to be more common in men, was found more often in women with previously undiagnosed disease. Iron deficiency in young women may be associated with poor school performance, even before anemia develops. Finally, major relief has been found for patients with multiple myeloma and bone pain.
Thromboembolic Disease
The major advance seen in thromboembolic disease in the past year was the use of low-molecular-weight heparin as at-home treatment of uncomplicated deep venous thromboses. In addition, new, previously unappreciated risks for the development of thromboembolic disease were elucidated. These risks include increased levels of homocysteine; previous spontaneous thromboembolism; and, to a much lesser degree, the use of estrogen replacement therapy.
Low-Molecular-Weight Heparin Was Effective for Home Use
Levine M, Gent M, Hirsh J, et al. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med. 1996; 334:677-81.
Proximal deep venous thrombosis is a common and potentially dangerous clinical problem. The actual incidence of the condition is unknown because many affected patients do not seek medical help. However, the most serious consequence of deep venous thrombosis, pulmonary embolism, causes at least 250 000 hospitalizations and 50 000 deaths per year in the United States.
Hospitalization to initiate treatment with unfractionated sodium heparin, followed by longer-term anticoagulation with warfarin, has been the traditional approach to treating deep venous thrombosis. Optimal duration of heparin therapy is unknown, but clinicians use the drug until warfarin becomes effective, typically for 5 to 6 days.
The use of unfractionated heparin is fraught with problems, however. Because the anticoagulant effects of …
