Publications by authors named "Cyrus C Hsia"

41 Publications

Cost-effectiveness of eltrombopag versus intravenous immunoglobulin for the perioperative management of immune thrombocytopenia.

Blood Adv 2021 Nov 15. Epub 2021 Nov 15.

McMaster University, Hamilton, Canada.

Eltrombopag has been shown to be non-inferior to intravenous immunoglobulin (IVIG) for improving perioperative platelet counts in patients with immune thrombocytopenia (ITP) in a randomized trial; thus, cost is an important factor for treatment and policy decisions. We used patient-level data from the trial to conduct a cost-effectiveness analysis comparing perioperative eltrombopag 50mg daily starting dose, with IVIG 1 or 2g/kg (according to local practice) from a Canadian public healthcare payer's perspective over the observation period, from preoperative day 21 to postoperative day 28. Resource utilization data were obtained from the trial data (eltrombopag, n=38; IVIG, n=36) and unit costs were collected from the Ontario Schedule of Benefits, Ontario Drug Formulary, and secondary sources. All costs were adjusted to 2020 Canadian dollars. We calculated the incremental cost per patient for all patients randomized. Uncertainty was addressed using non-parametric bootstrapping. The use of perioperative eltrombopag for patients with ITP resulted in a cost-saving of $413 Canadian dollars per patient. Compared with IVIG, the probability of eltrombopag being cost-effective was 70% even with zero willingness to pay. In a sensitivity analysis based on IVIG dose, we found that with the higher dose of IVIG (2g/kg), eltrombopag saved $2,714 per patient; whereas with the lower dose of IVIG (1g/kg), eltrombopag had a higher mean cost of $562 per patient. In summary, based on data from the randomized trial that demonstrated non-inferiority, the use of eltrombopag for the management of ITP in the perioperative setting was less costly than IVIG.
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http://dx.doi.org/10.1182/bloodadvances.2021005627DOI Listing
November 2021

Reducing cytogenetic testing in the era of next generation sequencing: Are we choosing wisely?

Int J Lab Hematol 2021 Oct 29. Epub 2021 Oct 29.

Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.

Introduction: In most laboratories, next generation sequencing (NGS) has been added without consideration for redundancy compared to conventional cytogenetics (CG). We tested a streamlined approach to genomic testing in patients with suspected myeloid and plasma cell neoplasms using next generation sequencing ("NGS first") as the primary testing modality and limiting cytogenetics (CG) to samples with morphologic abnormalities in the marrow aspirate.

Methods: Based on morphologic interpretation of bone marrow aspirate and flow cytometry, samples were triaged into four groups: (a) Samples with dysplasia or excess blasts had both NGS and karyotyping; (b) Samples without excess blasts or dysplasia had NGS only; (c) Repeat samples with previous NGS and/or CG studies were not retested; (d) Samples for suspected myeloma with less than 5% plasma cell had CG testing cancelled.

Results: Seven hundred eleven adult bone marrow (BM) samples met the study criteria. The NGS first algorithm eliminated CG testing in 229/303 (75.6%) of patients, primarily by reducing repeat testing. Potential cost avoided was approximately $124 000 per annum. Hematologists overruled the triage comment in only 11/303 (3.6%) cases requesting CG testing for a specific indication.

Conclusions: Utilizing NGS as the primary genomic testing modality NGS was feasible and well accepted, reducing over three quarters of all CG requests and improving the financial case for adoption of NGS. Key factors for the success of this study were collaboration of clinical and genomic diagnostic teams in developing the algorithm, rapid turnaround time for BM interpretation for triage, and communication between laboratories.
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http://dx.doi.org/10.1111/ijlh.13747DOI Listing
October 2021

Anémie grave induite par l’azathioprine et potentialisée par l’emploi concomitant d’allopurinol.

CMAJ 2021 03;193(13):E460-E463

Département de médecine (Madrazo, Jones) et division d'hématologie (Hsia), Département de médecine, Centre des sciences de la santé de London, Université Western Ontario, London, Ont.

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http://dx.doi.org/10.1503/cmaj.201022-fDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099162PMC
March 2021

Cabot rings in acute myeloid leukemia.

Blood 2021 03;137(11):1560

London Health Sciences Centre.

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http://dx.doi.org/10.1182/blood.2020009744DOI Listing
March 2021

Azathioprine-induced severe anemia potentiated by the concurrent use of allopurinol.

CMAJ 2021 01;193(3):E94-E97

Department of Medicine (Madrazo, Jones) and Division of Hematology (Hsia), Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ont.

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http://dx.doi.org/10.1503/cmaj.201022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835086PMC
January 2021

Clinical value of next-generation sequencing compared to cytogenetics in patients with suspected myelodysplastic syndrome.

Br J Haematol 2021 02 25;192(4):729-736. Epub 2020 Jun 25.

Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.

Next-generation sequencing (NGS) increasingly influences diagnosis, prognosis and management of myelodysplastic syndrome (MDS). In addition to marrow morphology and flow cytometry, our institution performs cytogenetics (CG) and NGS-based testing routinely in patients with suspected MDS. We evaluated the relative value of NGS in the assessment of patients with suspected MDS. We initially compared the diagnostic and prognostic information derived from CG and NGS in 134 patients. NGS enhanced the diagnostic yield compared to CG for clonal myeloid disorders (sensitivity 77% vs. 42·2%; specificity 90·2% vs. 78%; positive predictive value 92·8% vs. 76%; and negative predictive value 70·8% vs. 45·5%). The identification of poor prognosis mutations by NGS altered risk category in 27/39 (69·2%) patients with MDS with good/intermediate risk CG. Subsequently, we prospectively evaluated 70 patients with suspected MDS using an 'NGS-first approach' with CG restricted to samples with morphological abnormalities. We rarely identified mutations or CG abnormalities in patients without dysplastic features. NGS has a superior diagnostic performance compared to CG in patients with suspected MDS. We estimate that by using an 'NGS-first approach' we could reduce karyotyping by approximately 30%.
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http://dx.doi.org/10.1111/bjh.16891DOI Listing
February 2021

Transfusion Camp: a prospective evaluation of a transfusion education program for multispecialty postgraduate trainees.

Transfusion 2019 06 4;59(6):2141-2149. Epub 2019 Apr 4.

Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada.

Background: The optimal method of providing transfusion medicine (TM) education has not been determined. Transfusion Camp was established in 2012 at the University of Toronto as a centrally delivered TM education program for postgraduate trainees. The impact of Transfusion Camp on knowledge, attitudes, and self-reported behavior was evaluated.

Methods: Didactic lectures (delivered locally, by webinar, or recorded) and locally facilitated team-based learning seminars were delivered over 5 days during the academic year to 8 sites: 7 in Canada and 1 in the United Kingdom. Knowledge assessment using a validated 20-question multiple-choice exam was conducted before and after Transfusion Camp. Attitudes and self-reported behavior were collected through a survey.

Results: Over 2 academic years (July 2016 to June 2018), 390 trainees from 16 different specialties (predominantly anesthesia, 41%; hematology, 14%; and critical care, 7%) attended at least 1 day of Transfusion Camp. The mean pretest score was 10.3 of 20 (±2.9; n = 286) compared with posttest score of 13.0 (±2.8; n = 194; p < 0.0001). Lower pretest score and greater attendance (4-5 days compared with 1-3 days) were associated with larger improvement in posttest score; delivery format, specialty, and postgraduate year were not. Trainees reported an improvement in self-rated abilities to manage TM scenarios; 95% rated TM knowledge as very or extremely important in providing patient care; and 81% indicated that they had applied learning from Transfusion Camp into clinical practice.

Conclusions: Transfusion Camp increased TM knowledge, fostered a positive attitude toward TM, and enabled a self-reported positive impact on transfusion practice in postgraduate trainees. It is a novel and scalable approach to delivering TM education.
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http://dx.doi.org/10.1111/trf.15284DOI Listing
June 2019

Case report of granular acute lymphoblastic leukemia and review of the literature.

Clin Case Rep 2019 Jan 21;7(1):123-127. Epub 2018 Nov 21.

Department of Medicine, Division of Hematology London Health Sciences Centre London Ontario Canada.

Granular acute lymphoblastic leukemia (ALL) is a rare variant of the disease that is associated with a lower remission rate to standard induction chemotherapy. Flow immunophenotyping, cytogenetics, and molecular diagnostics should be utilized to confirm the diagnosis of ALL versus acute myeloid leukemia (AML) in order to provide appropriate management.
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http://dx.doi.org/10.1002/ccr3.1866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6333071PMC
January 2019

Gaucher disease screening at a general adult hematology tertiary care centre: A prospective study.

Int J Lab Hematol 2019 06 4;41(3):e66-e69. Epub 2018 Dec 4.

Division of Hematology, Department of Medicine, Western University, London, Ontario, Canada.

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http://dx.doi.org/10.1111/ijlh.12960DOI Listing
June 2019

Chronic Myelomonocytic Leukemia Mimicking Invasive Fungal Rhinosinusitis.

Can J Neurol Sci 2018 09;45(5):596-598

6Departments of Clinical Neurological Sciences and Ophthalmology,Western University,London,Ontario,Canada.

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http://dx.doi.org/10.1017/cjn.2018.320DOI Listing
September 2018

A Unique Hairy Cell Leukemia Variant.

Case Rep Oncol 2016 May-Aug;9(2):312-6. Epub 2016 Jun 10.

Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ont., Canada.

A 65-year-old woman presented with easy bruising, left upper quadrant pain, decreased appetite, and weight loss. She had splenomegaly and lymphocytosis (lymphocyte count of 11.6 × 10(9)/l), with remarkably abnormal appearing morphology. Her hemoglobin and platelet counts were normal. Peripheral blood flow cytometry revealed a monoclonal B-cell population expressing CD11c, CD25, CD19, CD20, and CD103. An initial diagnosis of hairy cell leukemia (HCL) was made, and the patient was treated with a standard 5-day course of cladribine. However, her lymphocytosis improved transiently, with a relapse 4 months later. There was no improvement in her splenomegaly. An HCL variant (HCL-v) was considered based on her resistance to treatment with a purine nucleoside analog. A subsequent splenectomy improved symptoms. Two years after, the patient suffered a relapse and underwent 6 cycles of CHOP-R (cyclophosphamide, hydroxydaunomycin, oncovin, prednisone, and rituximab), achieving partial remission. While under observation, she progressed with lymphocytosis 6 months later and was treated with pentostatin. There was no significant improvement in her disease, and she died 8 weeks following treatment initiation. HCL-v is a clinically more aggressive mature B-cell lymphoma than HCL with worse splenomegaly, higher lymphocyte counts, and resistance to typical HCL therapy with purine nucleoside analogs. Early recognition of HCL-v in the history, physical examination, and investigations with morphology and flow cytometry is key to patient management. Further, as in our case of HCL-v, cell morphology can be distinctly atypical, with large nucleoli and extremely convoluted nuclei. The distinction between HCL and HCL-v is important as HCL-v patients require more aggressive therapy and closer follow-up.
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http://dx.doi.org/10.1159/000446696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939668PMC
July 2016

Red blood cell processing methods and in-hospital mortality: a transfusion registry cohort study.

Lancet Haematol 2016 May 4;3(5):e246-54. Epub 2016 Mar 4.

Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada.

Background: Quality of red blood cells (RBCs) varies depending on the method of processing the whole blood donation, and the method of processing might affect outcomes in patients transfused RBCs. We aimed to establish whether an association exists between in-hospital mortality and RBC processing method and duration of storage.

Methods: We did a retrospective registry cohort study using data from three acute care hospitals in Hamilton, ON, Canada, and Canadian Blood Services over a 6-year period (2008-14). Adult patients (≥18 years) who were admitted to hospital and who received RBC transfusions were included in the study. All transfused RBCs were characterised by the method of processing (red cell filtered or whole blood filtered) and storage age (fresh 1-7 days, mid 8-35 days, and old 36-42 days). The primary outcome was in-hospital mortality. We used Cox proportional hazards regression with time-dependent stratification variables and fixed stratification variables, and controlled for patient covariates.

Findings: Between April 1, 2008, and March 31, 2014, 91 065 RBC transfusions were given to 23 634 adults who were included in the analyses. When storage duration was included in the model, in-hospital mortality was significantly increased with fresh whole blood filtered units compared with the reference group of mid-age red cell filtered units (hazard ratio 2·19, 95% CI 1·09-4·42; p=0·033). Differences between other age and processing categories were not significant.

Interpretation: The potential effect of whole blood processing methods on patient outcomes is worthy of further investigation, since adverse outcomes could be reduced by minor changes to blood processing methods and inventory management policies.

Funding: Canadian Blood Services, Health Canada, and the Canadian Institutes of Health Research.
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http://dx.doi.org/10.1016/S2352-3026(16)00020-XDOI Listing
May 2016

Randomized double-blind safety comparison of intravenous iron dextran versus iron sucrose in an adult non-hemodialysis outpatient population: A feasibility study.

BMC Hematol 2016 11;16. Epub 2016 Mar 11.

Department of Medicine, Division of Hematology, London, ON Canada ; University of Western Ontario, London, ON Canada ; Department of Epidemiology & Biostatistics, London, ON Canada.

Background: Intravenous iron therapy is a treatment option for iron deficient patients who are intolerant to oral iron or where oral iron is ineffective, but with possible adverse effects. Currently, prospective studies comparing different intravenous iron formulations are needed to determine safety and efficacy of these agents.

Methods: We conducted a prospective, double-blind, randomized controlled trial (RCT) to assess the feasibility of a trial comparing the safety of high molecular weight intravenous iron dextran, Infufer®, with intravenous iron sucrose, Venofer®, in non-hemodialysis adult outpatients. Primary outcome was the occurrence of immediate severe drug reactions.

Results: We enrolled 143 patients in a one-year period. Overall, 45/143 (31.5 %) patients (20 iron dextran, 25 iron sucrose) developed 48 infusion reactions (14 immediate, 28 delayed, and 3 both). The risk of an immediate reaction was similar in both groups, 9/73 (12.3 %) iron dextran versus 8/70 (11.4 %) iron sucrose, RR = 0.93 (95 % CI; 0.38 to 2.27). The risk of a delayed reaction was significantly higher in the iron sucrose group 22/70 (31.4 %) versus the iron dextran group 9/73 (12.3 %), RR = 2.55 (95 % CI; 1.26 to 5.15; p = 0.0078).

Conclusion: In this limited feasibility study, no major differences in immediate reactions were seen, but a significantly higher number of delayed reactions were seen in the iron sucrose group. Further, under our assumptions and design a full RCT to evaluate the safety of different intravenous iron preparations is not feasible. Future studies should consider modifying the clinical outcomes, utilize multiple centers, and consider other emerging parenteral iron formulations. (ClinicalTrials.gov NCT005936197 January 3, 2008).
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http://dx.doi.org/10.1186/s12878-016-0046-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788943PMC
March 2016

Use of n-of-1 (single patient) trials to assess the effect of age of transfused blood on health-related quality of life in transfusion-dependent patients.

Transfusion 2016 05 2;56(5):1192-200. Epub 2016 Feb 2.

Department of Medicine, Division of Hematology, Western University, London Health Sciences Centre, London, Ontario.

Background: The impact of age of red blood cells on health-related quality of life (HRQL) in patients who require chronic transfusions is not known. We assessed this using n-of-1 trials in patient populations where large randomized trials have not been done to date.

Study Design And Methods: Chronically transfusion-dependent adult patients were randomly assigned over time to four fresh (<7 days of storage) and four standard-issue (up to 42 days of storage) blood transfusions in prospective double-blinded multicrossover studies (n-of-1 trials). HRQL questionnaires were completed before and at 24 hours after each transfusion. Hemoglobin (Hb) levels were measured before each subsequent transfusion.

Results: Twenty transfusion-dependent patients were enrolled, of whom nine (five myelodysplastic syndromes, two myelofibrosis, one β-thalassemia major, one Diamond-Blackfan anemia) completed at least six transfusions. Mean ages of fresh and standard-issue blood transfused were 4.0 and 23.2 days, respectively. There were no significant differences in the effect of standard and fresh blood on follow-up Hb levels or the eight HRQL dimensions assessed in all analyses.

Conclusions: In chronically transfused patients, there were no significant differences in HRQL or Hb levels between fresh versus standard blood. While larger trials are needed, these results support current practices in hospital blood transfusion laboratories using a first-in, first-out model of blood utilization for these transfusion-dependent patients. Use of n-of-1 trials to determine the benefits of transfusions in single patients appears to be feasible.
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http://dx.doi.org/10.1111/trf.13484DOI Listing
May 2016

Safe utilization of ibrutinib with or without steroids in chronic lymphocytic leukemia patients with autoimmune hemolytic anemia.

Ann Hematol 2015 Dec 3;94(12):2077-9. Epub 2015 Sep 3.

Department of Medicine, Division of Hematology, London Health Sciences Centre, Room E6-219A, Victoria Hospital, 800 Commissioners Road East, London, Ontario, Canada, N6A 4G5.

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http://dx.doi.org/10.1007/s00277-015-2487-8DOI Listing
December 2015

Incidence and natural history of intravenous immunoglobulin-induced aseptic meningitis: a retrospective review at a single tertiary care center.

Transfusion 2015 Nov 20;55(11):2597-605. Epub 2015 Jun 20.

Division of Hematology, Department of Medicine, London Health Sciences Centre, Victoria Hospital.

Background: Aseptic meningitis is a rare but significant complication of intravenous immunoglobulin (IVIG) therapy. The majority of literature is limited to case reports, so the true incidence of this complication is uncertain.

Study Design And Methods: A retrospective review of all cases of IVIG-associated adverse transfusion reactions was performed at London Health Sciences Centre (LHSC) from January 1, 2008, to December 31, 2013. All reported transfusion reactions were evaluated to identify cases of aseptic meningitis due to IVIG. All documented IVIG infusions and lumbar punctures performed during the study period were reviewed; patients with both interventions were identified and further chart review was performed to identify aseptic meningitis.

Results: During our study period, 1324 unique patients received a total of 11,907 IVIG infusions (554,566 g) for various conditions. Eight cases of aseptic meningitis were identified, suggesting an overall incidence of 0.60% for all patients and 0.067% for all IVIG infusions. Patients presented with symptoms within 24 to 48 hours of the infusion and were treated with antibiotics initially. The reactions were self-limited, as symptoms self-resolved within 5 to 7 days. Treatment was supportive, with subsequent IVIG infusions likely requiring preinfusion medication or possibly a switch in product formulation.

Conclusion: This review of IVIG-induced aseptic meningitis over a 6-year period identifies a more robust estimate of incidence and risk of 0.60% and 0.067% for all patients and infusions, respectively. Given that this complication can mimic infectious meningitis and cause considerable morbidity, physicians need to be aware of this rare but important condition.
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http://dx.doi.org/10.1111/trf.13200DOI Listing
November 2015

Combined accurate platelet enumeration and reticulated platelet determination by flow cytometry.

Cytometry B Clin Cytom 2015 Sep-Oct;88(5):330-7. Epub 2015 Apr 22.

Pathology and Laboratory Medicine, London Health Sciences Centre and St. Joseph's Health Care London, London, Ontario, N6A 4G5, Canada.

Background: Diagnosing the cause of thrombocytopenia often requires a bone marrow aspiration or biopsy, an invasive procedure. Reticulated platelets (RP) are immature RNA containing platelets, accurate RP enumeration has yet to be achieved, partially due to the lack of a robust reference method.

Goal: To refine previous work and gating strategies distinguishing RP from mature platelets while incorporating accurate platelet enumeration into the analysis. After reviewing previously published studies on Thiazole Orange (TO) staining of RP, we systematically evaluated CD41/CD61 in combination with a commercial source of TO (BDBiosciences). Previous RP methods have not taken advantage of platelet enumeration therefore our goal was to incorporate the ICSH platelet enumeration protocol into our method.

Methods: TO concentration, incubation, and fixation method were determined to be 10% of stock concentration, 30 min, and 1% formaldehyde respectively. Gating strategy to determine RP fraction used an unstained control tube to set the limit of TO staining.

Results: Normal range (n = 51) was 9.9 ± 3.1%. Analysis of 40 patients with immune-thrombocytopenia-purpura (ITP) showed a RP range from 4.3% to 81.2%. Platelet enumeration was consistent with our previous studies in this area.

Conclusions: Combining CD41/CD61 platelet enumeration with TO RP percentage is possible. Accurate RP percentage requires an effective gating strategy, as background fluorescence cursor placement is important. This method for enumeration of RP percentage combined with accurate platelet enumeration, particularly in the low range, should prove useful in differentiating production from consumption issues in thrombocytopenia and monitoring response to therapy.
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http://dx.doi.org/10.1002/cyto.b.21245DOI Listing
May 2016

Intravenous Immunoglobulin (IVIg) Utilization in Immune Thrombocytopenia (ITP): A Multi-Center, Retrospective Review.

Drugs Real World Outcomes 2015 Mar;2(1):35-42

Department of Medicine, McMaster University, Hamilton, ON, Canada.

Introduction: Intravenous immunoglobulin (IVIg) is an immune thrombocytopenia (ITP) therapy, which is associated with toxicities, limited availability, increasing utilization, and high cost. This study aimed to assess short- and long-term IVIg utilization in patients with ITP at two tertiary care centers in Ontario, Canada, to determine the proportion of IVIg used in ITP compared with all usage, and to forecast IVIg demand in ITP.

Methods: Records from all adult ITP patients who received IVIg between January 1, 2003, and September 30, 2012, at Hamilton Health Sciences and London Health Sciences Centre were reviewed retrospectively.

Results: During the study period, 383 adult ITP patients (mean age 51.3 years) received a total of 2,098 IVIg infusions (London 547 infusions in 150 patients; Hamilton 1,551 infusions in 233 patients). ITP accounted for 5.6 and 9.1 % of all IVIg usage in London and Hamilton, respectively. The treatments included 264 (53.7 %) acute, 172 (35.0 %) short-term, and 56 (11.4 %) long-term treatments. The amounts of IVIg used for short- and long-term treatment of ITP are forecasted to be approximately 5,000 and 11,000 g per year, respectively, up to 2018. Together, these two centers represent 19.9 % of the provincial IVIg utilization. Assuming similar patient populations and practice patterns in Ontario, the overall provincial cost of IVIg use in ITP may be as high as $5 million annually.

Conclusion: Short- and long-term IVIg utilization for ITP will remain an expensive resource within the Ontario provincial health care system. Physicians and policy makers should reflect on the impact of treating ITP with IVIg and should consider alternatives, where appropriate, to improve patient quality of life and decrease economic costs.
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http://dx.doi.org/10.1007/s40801-015-0009-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4883208PMC
March 2015

Response to "Need to minimize bias when surveying patient attitudes to stopping cml treatment".

Curr Oncol 2014 Dec;21(6):e803-4

Department of Medicine, Division of Hematology, London Health Sciences Centre, University of Western Ontario, Victoria Hospital, Room E6-219A, 800 Commissioners Road East, London, Ontario,

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http://dx.doi.org/10.3747/co.21.2200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257128PMC
December 2014

Light chain deposition.

Blood 2013 Jun;121(26):5111

London Health Sciences Centre.

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http://dx.doi.org/10.1182/blood-2013-01-477265DOI Listing
June 2013

Histoplasmosis-induced pancytopenia.

Blood 2012 Oct;120(15):2937

London Health Sciences Centre.

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http://dx.doi.org/10.1182/blood-2012-03-417782DOI Listing
October 2012

Cerebrospinal fluid plasmacytosis.

Blood 2012 Oct;120(15):2936

London Health Sciences Centre.

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http://dx.doi.org/10.1182/blood-2012-03-417816DOI Listing
October 2012

Dapsone hemolysis.

Blood 2012 Jun;119(23):5349

London Health Sciences Centre, UK.

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http://dx.doi.org/10.1182/blood-2011-07-365544DOI Listing
June 2012

Peripheral blood candidiasis.

Blood 2012 May;119(21):4822

London Health Sciences Centre.

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http://dx.doi.org/10.1182/blood-2011-09-378737DOI Listing
May 2012

Acute nonlymphocytic leukemia presenting with pancytopenia.

Blood 2012 Feb;119(6):1333

London Health Sciences Centre.

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http://dx.doi.org/10.1182/blood-2011-01-331850DOI Listing
February 2012

May-Hegglin anomaly.

Blood 2012 Jan;119(2):328

London Health Sciences Centre, ON, Canada.

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http://dx.doi.org/10.1182/blood-2010-12-325431DOI Listing
January 2012
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