Free Hematology CME

Activity Description / Statement of Need:

In this online, self-learning activity:

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired, hematopoietic stem cell disorder characterized by complement-mediated destruction and loss of erythrocytes and the eponymous clinical manifestation of pink-red discoloration of the urine due to presence of hemoglobin. PNH is a rare disorder with a reported incidence of clinically significant disease of between 1 to 2 cases per million. However, it is possible that this range may be underestimated, as a subset of patients remain undiagnosed. PNH occurs worldwide with no known specific ethnic or geographic distribution patterns.

Approximately 40% of patients with PNH saw at least five or more specialists before receiving a diagnosis. PNH diagnosis is complicated by the rarity of the disorder and the nonspecific findings, meriting continuing healthcare educational programming.

Target Audience:

The following healthcare professionals: Hematologists; physician assistants, nurse practitioners, and pharmacists specializing in hematology and transplant medicine; and any other healthcare professionals with an interest in or who may clinically encounter patients with PNH.

Activity Description / Statement of Need:

In this online, self-learning activity:

Immune thrombocytopenia (ITP) is a phenomenon characterized by a peripheral platelet count of less than 100 x 109/L in the absence of any discernable cause, with an increased risk of bleeding. Also known as thrombocytopenic purpura, it occurs in around two to four cases per 100,000 adults, with incidence peaking bimodally: Once between 20-30 years with female predominance and also at 60 years with even distribution between the sexes.

The diagnosis of ITP is one of exclusion and includes platelet autoantibody testing. However, it is complicated and associated with documented gaps in care, with preventable delays in diagnosis and misdiagnosis not uncommon. One study found that one in seven patients diagnosed with ITP were misdiagnosed and reclassified as they received additional clinical evaluation. Another study found that over 22% of patients with ITP did not receive guideline-recommended peripheral blood film examination. These diagnostic challenges have real-world consequences on patient lives, creating anxiety in 73% of patients who experience a delayed diagnosis.

Treatment goals include prevention of severe bleeding episodes, maintaining platelet counts for symptomatic patients, minimizing treatment toxicity, and maximizing health-related quality of life. Conventional therapy includes corticosteroids, intravenous immunoglobulin (IVIg), and anti-D IVIg. However, treatment challenges remain, including variability in practice between providers and high rates of relapse between following standard first-line therapies together with considerable patient frustration. Moreover, some patient subpopulations are more challenging to treat and are less likely to achieve therapeutic success.

Target Audience:

HCPs specializing in: hematology; physician assistants, nurse practitioners, nurses, pharmacists; and any other healthcare professionals with an interest in or who clinically encounter patients with ITP.

Activity Description / Statement of Need:

In this online, self-learning activity:

Hemophilia is a genetic disease caused by mutation of one of the genes for coagulation proteins leading to dangerous, uncontrolled bleeding. In hemophilia B, a mutation in the gene for factor IX (FIX) leads to an endogenous deficiency in the clotting factor. The incidence of hemophilia B is the same in all geographic regions, populations, and ethnic groups, affecting approximately 1 out of every 30,000 male births. The condition is diagnosed by measuring FIX activity, and patients with severe hemophilia have levels of 1% or less. Patients with severe hemophilia B are at risk for spontaneous, life-threatening bleeding episodes. Untreated, the life expectancy is approximately 20 years, and painful or even life-threatening morbidities include: intracranial hemorrhage, severe bleeding in other organ systems, musculoskeletal injury, and joint injury. In contrast, in people with moderate or mild hemophilia, abnormal bleeding usually occurs after minor trauma or surgery. Unfortunately, the literature shows that not only do clinicians struggle with the classification of hemophilia severity and that there are gaps in knowledge present that contribute to delayed diagnosis and treatment, with an attendant increase in morbidity and mortality. Challenges in diagnosis and classification are only the first of several gaps in care that patients with hemophilia face.

Target Audience:

The following HCPs: hematologists and pediatricians; physician assistants, nurse practitioners, and pharmacists who practice in hematology, and other HCPs who practice in hemophilia treatment center; and any other clinicians with an interest in or who clinically encounter patients with hemophilia B.

Activity Description / Statement of Need:

In this online, self-learning activity:

Pyruvate kinase (PK) is an enzyme that plays a major role in a metabolic pathway integral to the production of ATP, and a deficiency in the enzyme (PKD) is one of the most common enzyme-related glycolytic defects in a pathway integral to the production of ATP. It is transmitted as an autosomal recessive trait and is caused by mutations in the PKLR gene on chromosome 1, and over one hundred eighty of these mutations have been associated with PKD. While PKD affects approximately five people of European descent per 100,000 (data in other patient populations are lacking), it is one of the more frequent causes of chronic hemolysis. Anemia arising from the condition may range from mild and fully compensated to life-threatening in severity.

Target Audience:

Healthcare professionals specializing in: hematology; nurse practitioners, physician assistants, and pharmacists who specialize in hematology; and those who otherwise commonly care for or clinically encounter patients with PKD.

Activity Description / Statement of Need:

In this online, self-learning activity:

Neutropenia, a decrease in the number of a type of white blood cell (WBC) in the body, is a common complication in patients undergoing myelosuppressive chemotherapy that can result in serious, life-threatening infections. Febrile neutropenia (FN), or neutropenia accompanied by a fever, poses an even greater risk to patients and the frequent treatment complication results in over 100,000 hospitalizations in the U.S. each year. Neutropenia can manifest up to twelve days following treatment with a chemotherapy agent and FN occurs in about eight per 1,000 patients receiving chemotherapy. Fever is defined as a single oral temperature of 38.3+ °C or 38.0+ °C over the course of an hour, with neutropenia defined as less than 500 neutrophils/mcL or less than 1000 with a predicted decline to less 500 over the following 48 hours. Development of FN may lead to hospitalization with costs estimated at approximately $15,000 per visit, and it may also complicate care by reducing chemotherapy relative dose intensity (RDI) and possibly compromise treatment efficacy and lower survival rates.

Target Audience:

Oncologists and hematologists; physician assistants, nurse practitioners, and pharmacists who practice in oncology; and other HCPs with an interest in or who clinically encounter patients with FN or at risk of developing it.

Activity Description / Statement of Need:

In this online, self-learning activity:

Myelofibrosis (MF) is a hematologic malignancy characterized by fibrosis buildup in the bone marrow, inadequate hematopoiesis, and splenomegaly. MF is a rare form of cancer, with an incidence of about 0.4 per 100,000 person-years in the United States. MF is the most aggressive form of the Philadelphia-negative, BCR-ABL1 chronic myeloproliferative neoplasms, with a five-year mortality rate of 51%. In patients with other comorbidities at the time of or after diagnosis, such as diabetes, hypertension, pulmonary diseases, or obesity, even greater reductions in lifespan can be expected. It has a considerable effect on patient quality of life and is associated not only with feelings of fear, anger, and grief common of an oncologic diagnosis, but also a gradual loss of ability to perform activities of daily living and hobbies. MF imposes a significant financial burden through direct and indirect costs, and patients who are diagnosed at a younger age often become unemployed as the disease progresses.

Target Audience:

The following HCPs: hematologists and oncologists in the community and academic settings; physician assistants, nurse practitioners, and pharmacists who practice in oncology; and any other HCPs with an interest in or who clinically encounter patients with MF.

Activity Description / Statement of Need:

In this online, self-learning activity:

Graft-versus-host disease (GvHD) is an immune-mediated response that occurs in recipients of allogenic hematopoietic cell transplantation (HCT). GvHD can be further categorized into acute and chronic cases. Maculopapular rash, follicular erythema, epidermolysis, are common manifestations of acute GvHD, in addition to liver and gastrointestinal dysfunction such as hyperbilirubinemia, nausea, and diarrhea. This activity focuses on chronic GvHD, which has more extensive multi-organ involvement including the liver, eyes, mouth, lungs, skin, genitalia, and gastrointestinal tract.

Target Audience:

The following HCPs: hematologists and oncologists; nurse practitioners, physician assistants, and pharmacists who specialize in oncology; and those who otherwise commonly care for or clinically encounter patients with GVHD.

Activity Description / Statement of Need:

In this online, self-learning activity:

Thalassemias are a group of recessively inherited blood disorders characterized by little or no hemoglobin production and chronic anemia of varying severity. Beta-thalassemia (BT) is most commonly found in people of Mediterranean, Middle Eastern, Asian, and North African descent. Worldwide, 1.5% of people are BT carriers, with about 40,000 infants born with BT annually. About half of patients with BT are transfusion-dependent, which may significantly impact patient quality of life. BT is caused by a point mutation in the gene encoding hemoglobin subunit beta (HBB), resulting in either lower beta-globin production (termed beta-plus [B⁺]) or the prevention of all beta-globin production (termed beta-zero [B⁰]). Disease severity depends on the extent of hemoglobin β and γ chain imbalance.

Target Audience:

The following HCPs: hematologists; physician assistants, nurse practitioners, and pharmacists who practice in hematology; and any other healthcare professionals with an interest in or who may clinically encounter patients with beta-thalassemia.