Hematology – ClinCaseQuest

Multiple Myeloma Diagnostic Criteria – Online Calculator

clincasequest — Sun, 05 Feb 2023 18:46:01 +0000

Email (indicate if you want the results to be sent to your email)

Date of assessment

≥1 of the following (A or B)

A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

Result

Diagnostic result

Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result

Positive for multiple myeloma by IMWG criteria

Details:

* Required

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the appropriate criteria:

Criteria

(A) Clonal bone marrow plasma cells ≥10% or (B) biopsy-proven bony or extramedullary plasmacytoma

AND

(C1) End organ damage attributable underlying plasma cell proliferative disorder, specifically:
- Hypercalcemia: serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L)
- Renal insufficiency: creatinine clearance <40 mL per min or serum creatinine >2 mg/dL (177 μmol/L)
- Anemia: hemoglobin >2 g/dL (20 g/L) below lower limit of normal, or hemoglobin <10 g/dL (100 g/L)
- Bone lesions: ≥1 osteolytic lesion on skeletal x-ray, CT, or PET-CT
(C2) ≥1 of the following biomarkers of malignancy:
- Clonal bone marrow plasma cells ≥60%
- Involved:uninvolved sFLC ratio ≥100
- >1 focal lesion on MRI

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Literature

Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538-48.

Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator

Revised Multiple Myeloma International Staging System (R-ISS) – prognostication tool for myeloma patients based on…

Multiple Myeloma International Staging System (ISS) Online Calculator

Multiple Myeloma International Staging System (ISS) prognosticates the severity of multiple myeloma based on routinely…

SAVED VTE Score

SAVED score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IMPEDE VTE Score

IMPEDE score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IPSET – Thrombosis Risk for essential thrombocythemia: Online Calculator

International Prognostic Score of thrombosis in World Health Organization – essential thrombocythemia (IPSET-thrombosis). IPSET-thrombosis model…

Сообщение Multiple Myeloma Diagnostic Criteria – Online Calculator появились сначала на ClinCaseQuest.

Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator

Nataliia Lopina — Tue, 17 Jan 2023 11:32:05 +0000

Revised Multiple Myeloma International Staging System (R-ISS) – prognostication tool for myeloma patients based on the genetics and other routinely used lab values in conjunction with the original ISS Staging System.

Use only in patients recently diagnosed with multiple myeloma. Do not use in patients with relapsed myeloma, smoldering myeloma or MGUS. Its utility has NOT been validated in relapsed myeloma, smoldering myeloma or MGUS patients.

Provides better discrimination of prognosis for MM by using simple, readily available variables.

Reliable, validated tool that may have a role in upfront risk stratification in future clinical trials, and also may help patients understand their prognosis better.

The revised ISS is based on the original ISS for MM and has been refined further to include validated and reliable prognostic factors for MM, including ISS score, cytogenetic abnormalities, and LDH.

It identifies 3 groups with clearly different outcomes and recharacterized ~25% of patients who would have been identified as good risk (misclassified as “good prognosis”) using only one of the validated factors into a higher risk category.

Unlike several other studies, the data set includes many patients (40%) that were not transplant eligible, thus reflecting a “real-world” population.

Serum β2 microglobulin	<3.5 mg/L
	3.5-5.4 mg/L
	>5.4 mg/L
Serum albumin	<3.5 g/dL
	≥3.5 g/dL
CA by iFISH High risk defined as: presence of del(17p) and/or translocation t(4;14) and/or translocation t(14;16)	Standard risk
	High risk
LDH	Normal (< upper limit of normal)
	High (> upper limit of normal)

First, assign ISS stage:

		Serum albumin, g/dL
		≥3.5	<3.5
Serum β2 microglobulin, mg/L	<3.5	ISS I	ISS II
	3.5-5.4	ISS II	ISS II
	≥5.5	ISS III	ISS III

Then, stage R-ISS according to iFISH and LDH:

	High-risk cytogenetic abnormalities by iFISH*
	No	Yes
ISS I	R-ISS I	R-ISS II	Normal	LDH
	R-ISS II	R-ISS II	High
ISS IІ	R-ISS II	R-ISS II	Normal
	R-ISS II	R-ISS II	High
ISS IІІ	R-ISS II	R-ISS III	Normal
	R-ISS III	R-ISS III	High

*High-risk = presence of del(17p) and/or translocation t(4;14) and/or translocation t(14;16).

R-ISS interpretation:

R-ISS Stage	Median progression-free survival
І	66 months
ІІ	42 months
ІІІ	29 months

Many MM patients are treated through clinical trials. Physicians may consider referring patients to academic treatment centers if they are eligible and willing to receive transplantation, not only to discuss standard treatment options, but also to consider clinical trial options.

Current staging systems provide prognostic information and are useful for stratification and data assessments/comparisons.

The R-ISS, though a more robust powerful prognostic tool compared to ISS, is NOT directly used to alter treatment recommendations outside of a clinical trial at this time.

The revised International Staging System (R-ISS) for multiple myeloma was developed to better prognosticate long term outcomes of myeloma patients using easily obtained and routinely used prognostic variables.

It includes the parameters from the International Staging System (ISS), as well as cytogenetic abnormalities (CA) serum lactate dehydrogenase (LDH).

The R-ISS creates 3 subgroups with significantly different overall survival:

Stage I: 82%
Stage II: 62%
Stage III: 40%

It risk-stratifies multiple myeloma patients better than the original ISS.

40% of patients in the data set were not transplant eligible, which reflects a more real-world population than does previous studies

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LITERATURE

Multiple Myeloma Diagnostic Criteria – Online Calculator

Email (indicate if you want the results to be sent to your email)

Date of assessment

≥1 of the following (A or B)

A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

Result

Diagnostic result

Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result

Positive for multiple myeloma by IMWG criteria

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the…

Multiple Myeloma International Staging System (ISS) Online Calculator

Multiple Myeloma International Staging System (ISS) prognosticates the severity of multiple myeloma based on routinely…

SAVED VTE Score

SAVED score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IMPEDE VTE Score

IMPEDE score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IPSET – Thrombosis Risk for essential thrombocythemia: Online Calculator

International Prognostic Score of thrombosis in World Health Organization – essential thrombocythemia (IPSET-thrombosis). IPSET-thrombosis model…

Сообщение Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator появились сначала на ClinCaseQuest.

Multiple Myeloma International Staging System (ISS) Online Calculator

Nataliia Lopina — Mon, 16 Jan 2023 15:05:06 +0000

Multiple Myeloma International Staging System (ISS) prognosticates the severity of multiple myeloma based on routinely obtained lab values.

Use only in patients recently diagnosed with multiple myeloma. Do not use in patients with relapsed myeloma, smoldering myeloma or MGUS. Its utility has not been validated in relapsed myeloma, smoldering myeloma or MGUS patients.

Multiple myeloma (MM) is a heterogeneous disease, with prognosis affected by various patient and disease related factors (ISS stage, genetics, performance status and other comorbidities).

The ISS differentiates patients into 3 separate prognostic groups. The staging is prognostic but does not necessarily guide treatment decisions in the upfront setting. It provides survival information to the physician and patient, and helps stratify patients in current clinical trials.

Staging based on serum β2 microglobulin and albumin levels.

Multiple Myeloma ISS interpretation:

Stage	Criteria
I	Serum β2 microglobulin <3.5 mg/L AND serum albumin ≥ 3.5 g/dL
II	Either: serum β2 microglobulin <3.5 mg/L, but serum albumin <3.5 g/dL OR serum β2 microglobulin 3.5 – 5.4 mg/L irrespective of the serum albumin
III	serum β2 microglobulin ≥5.5 mg/L

The International Staging System (ISS) for multiple myeloma defines 3 subgroups with differing overall survival:

Stage I- 62 months
Stage II- 44 months
Stage III- 29 months

The ISS was developed as a simpler, more objective tool to provide prognostic information for newly diagnosed, symptomatic MM patients.

It does not reflect disease burden.

Durie-Salmon, a cumbersome staging system used in the past, was based on estimating the disease burden but ultimately did not prove to be prognostic and fell out of favor.

Compared to older staging systems, ISS is a simple prognostic tool and may be used to stratify patients on MM clinical trials.

This system was developed from a database of clinical and laboratory data collected from 10,750 patients treated from 1981 to 2002. All patients were about to start therapy, ~70% through a clinical trial, and were from North America, Europe, and Asia. Approximately 25% received high-dose therapy/stem cell transplant. Median age was 60-63 years.

A randomly selected training set was created and analyzed by univariate and multivariate analysis, selecting serum beta-2 microglobulin and serum albumin as the dominant independent prognostic factors, best utilized in a survival tree model.

This model classified patients in 3 risk groups:

Stage I- median overall survival 62 months;
Stage II- 45 months;
Stage III- 29 months.

The ISS was then validated in a separate group of patients from the same database with virtually identical results. It was validated further by geography, patient age, and treatment type.

This model has been refined further as the Revised ISS (R-ISS). It includes validated and reliable prognostic factors for MM, including ISS score, cytogenetic abnormalities, and LDH. It identifies 3 groups with clearly different outcomes. It recharacterized ~ 25% of patients who would have been identified as good risk using only one of the validated factors into a higher risk category.

Register on our website right now to have access to more learning materials!

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LITERATURE

Multiple Myeloma Diagnostic Criteria – Online Calculator

Email (indicate if you want the results to be sent to your email)

Date of assessment

≥1 of the following (A or B)

A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

Result

Diagnostic result

Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result

Positive for multiple myeloma by IMWG criteria

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the…

Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator

Revised Multiple Myeloma International Staging System (R-ISS) – prognostication tool for myeloma patients based on…

SAVED VTE Score

SAVED score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IMPEDE VTE Score

IMPEDE score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IPSET – Thrombosis Risk for essential thrombocythemia: Online Calculator

International Prognostic Score of thrombosis in World Health Organization – essential thrombocythemia (IPSET-thrombosis). IPSET-thrombosis model…

Сообщение Multiple Myeloma International Staging System (ISS) Online Calculator появились сначала на ClinCaseQuest.

SAVED VTE Score

Nataliia Lopina — Wed, 11 Jan 2023 14:09:11 +0000

SAVED score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators.

Variable	Points
Surgery within 90 days	+2
Mongoloid race	-3
History of VTE	+3
Age ≥ 80 years	+1
Dexamethasone (dosage regimen): • Standard dose (120-160 mg/cycle) • High dose (>160 g/cycle)	+1 +2

Calculation

High risk (≥ 2 points). Recommended:

Enoxaparin 40 mg subcutaneously 1 time/day
Dalteparin 5000 units subcutaneously 1 time/day (category 2B)
Warfarin (INR 2-3)

Low risk (< 2 points). Recommended:

Do not prescribe medications
Aspirin 81-325 mg/day

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Multiple Myeloma Diagnostic Criteria – Online Calculator

Email (indicate if you want the results to be sent to your email)

Date of assessment

≥1 of the following (A or B)

A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

Result

Diagnostic result

Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result

Positive for multiple myeloma by IMWG criteria

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the…

Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator

Revised Multiple Myeloma International Staging System (R-ISS) – prognostication tool for myeloma patients based on…

Multiple Myeloma International Staging System (ISS) Online Calculator

Multiple Myeloma International Staging System (ISS) prognosticates the severity of multiple myeloma based on routinely…

IMPEDE VTE Score

IMPEDE score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IPSET – Thrombosis Risk for essential thrombocythemia: Online Calculator

International Prognostic Score of thrombosis in World Health Organization – essential thrombocythemia (IPSET-thrombosis). IPSET-thrombosis model…

Сообщение SAVED VTE Score появились сначала на ClinCaseQuest.

IMPEDE VTE Score

Nataliia Lopina — Wed, 11 Jan 2023 14:06:45 +0000

IMPEDE score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators.

*Individual Risk Factors*	Points	Myeloma risk scores	Points
Positive Factors
Central venous catheter/tunneled central catheter	+2	Immunomodulator (IM)	+4
Fracture of the pelvis, hip joint, or femur	+4	A drug that stimulates erythropoiesis	+1
Obesity (body mass index ≥ 25)	+1	Dexamethasone < 160 mg per month	+2
Previous VTE	+5	Dexamethasone > 160 mg per month	+4
		Doxorubicin or multicomponent chemotherapy	+3
Negative Factors
Ethnicity/Race – Mongoloid/Pacific Islander	-3
Current thromboprophylaxis: low molecular weight heparin (LMWH) at prophylactic doses or aspirin	-3
Current thromboprophylaxis: LMWH at prophylactic doses or warfarin	-4

Calculation

High risk (>3 points). An anticoagulant is recommended if it has not been prescribed before:

Enoxaparin 40 mg subcutaneously 1 time/day
Dalteparin 5000 units 1 time/day (category 2B)
Warfarin (INR 2-3)

Low risk (≤3 points). Recommended:

Do not prescribe medications
Aspirin 81-325 mg/day

Register on our website right now to have access to more learning materials!

Subscribe to our pages:

Multiple Myeloma Diagnostic Criteria – Online Calculator

Email (indicate if you want the results to be sent to your email)

Date of assessment

≥1 of the following (A or B)

A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

Result

Diagnostic result

Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result

Positive for multiple myeloma by IMWG criteria

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the…

Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator

Revised Multiple Myeloma International Staging System (R-ISS) – prognostication tool for myeloma patients based on…

Multiple Myeloma International Staging System (ISS) Online Calculator

Multiple Myeloma International Staging System (ISS) prognosticates the severity of multiple myeloma based on routinely…

SAVED VTE Score

SAVED score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…

IPSET – Thrombosis Risk for essential thrombocythemia: Online Calculator

International Prognostic Score of thrombosis in World Health Organization – essential thrombocythemia (IPSET-thrombosis). IPSET-thrombosis model…

Сообщение IMPEDE VTE Score появились сначала на ClinCaseQuest.

Checklist – Counseling “Explain a bone marrow aspiration”

Nataliia Lopina — Sun, 04 Dec 2022 22:28:25 +0000

Introduction	Points
Introduces and identifies patient	1
Gains consent	1
Explore
Checks patients understanding for reason for Bone Marrow Aspiration	2
Check’s patients understanding of the procedure	1
Inform
Preparation: Taken in as a day case	1
Procedure: Takes 10 minutes. You are laid on your back and given a local anaesthetic which is make it less sore. They tunnel a needle into you pelvis bone and suck out some cells. Then given a dressing over the site.	3
Post-procedure: Apply pressure over site for 5 minutes. Given pain medication. Will be sore for 2-3 days	2
Risks and complications
Very safe procedure. Bleeding may occur	2
Pain is the main problem post procedure	1
Closure
Any questions	1
Alleviate fears	1
Offer further information source	1
Closure
Gave information in chunks and tested understanding	1

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Сообщение Checklist – Counseling “Explain a bone marrow aspiration” появились сначала на ClinCaseQuest.

Checklist – Counseling “History of Acute Intermittent Porphyria”

Nataliia Lopina — Sun, 04 Dec 2022 21:07:31 +0000

Introduction	Points
Introduce and check the details	1
Consent	1
Presenting Compliant
Elicit intermittent nature of abdominal pain	1
Details on length of suffering and regularity of attacks	1
Dermal lesions: photosensitive	1
Autonomic activation/ GI: Vomiting, Hypertension, Constipation, neurological signs	1
Neurological: respiratory failure, cerebellar signs (DANISH),	1
Colour of urine	1
Elicit relapsing course	1
Family History: Autosomal dominant	1
Elicits trigger: Alcohol, infections, starvation, medication, menstrual period	2
Other
Past medical history: previous admissions and what happened	1
Medications	1
Social history: alcohol and smoking	1
Closure
Summarise findings	1
Question Investigations: urinary urobilinogen, FBC, U&E, LFTs, haematinics (increased iron), abnormal GTT, porphobilinogen deaminase in erythrocytes	1
Question Management: prevent triggers and supportive	1

Сообщение Checklist – Counseling “History of Acute Intermittent Porphyria” появились сначала на ClinCaseQuest.

Maximum Allowable Blood Loss (ABL) Without Transfusion: Online calculator

Nataliia Lopina — Thu, 12 May 2022 10:31:12 +0000

Maximum Allowable Blood Loss (ABL) Without Transfusion formula can be used in patients with blood loss, typically during surgery, who may need transfusion. The Maximum Allowable Blood Loss Without Transfusion calculator suggests how much blood can be lost, typically during surgery, before transfusion should be considered.

Maximum Allowable Blood Loss (ABL) Without Transfusion formula helps with determining when to transfuse a patient if blood count values are not immediately available.

Maximum Allowable Blood Loss (ABL) Without Transfusion calculated based on formula:

ABL = [EBV x (Hi-Hf)] / Hav, where EBV = body weight, kg x average blood volume*, mL/kg and other variables are as follows:

Variable	Description
ABL	Allowable blood loss
EBV	Estimated blood volume
H_i	Initial hemoglobin
H_f	Final hemoglobin (cutoff for transfusion)
H_av	Average of initial and final hemoglobin

*Average blood volume by age:

Age	Average blood volume, mL/kg
Adult man	75
Adult woman	65
Infant	80
Neonate	85
Premature neonate	96

Transfusion triggers vary by patient and clinical presentation.

Patients with hemoglobin concentrations below 6 g/dL almost always require transfusion. In stable patients with hemoglobin values 6-10 g/dL, the decision whether to transfuse is based on an evaluation of clinical status; patients with values above 10 g/dL rarely require transfusion unless they are unstable or have signs/symptoms consistent with continued hemorrhage.

During blood loss, dilution of remaining hemoglobin occurs as intravascular volume is maintained by fluid shifts and administration of fluids. Consider transfusing if estimated blood loss exceeds calculated allowable blood loss.

Estimating blood loss intraoperatively can be done via direct measure of blood in suction canister along with measuring soiled sponges.

This method is only an estimate to measure blood loss. Patient vitals and clinical signs should be evaluated clinically first.

Capacity by sponge type:

4x4s: ~10 mL blood
Gauze sponges (Ray-Tec):~10-20 mL blood
Laparotomy (lap) sponges: ~50-100 mL blood

Consider timing of blood loss. Acute blood loss may not present with a drop in hemoglobin. Always monitor clinical metrics such as hemodynamics and respiratory status along with anticipated blood loss.

The trigger to transfuse varies by patient.

The maximum allowable blood loss equation was developed by Jeffrey Gross based on an accepted equation for blood loss and incorporating a correction for isovolumetric hemodilution using a mathematical differential.

Gross in 1983 showed that a blood loss greater than 20% of estimated blood volume will cause the maximum allowable value to be inaccurate.

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Literature

Gross JB. Estimating Allowable Blood Loss Corrected for Dilution. Anesthesiology 58.2 (1983): 277-280.
Practice Guidelines for blood component therapy: A report by the American Society of Anesthesiologists Task Force on Blood Component Therapy.
Practice guidelines for blood transfusion: a compilation from recent peer-reviewed literature. American Red Cross.

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Multiple Myeloma Diagnostic Criteria – Online Calculator

February 5, 2023

Email (indicate if you want the results to be sent to your email)

Date of assessment

≥1 of the following (A or B)

A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

Result

Diagnostic result

Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result

Positive for multiple myeloma by IMWG criteria

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the…

Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator

January 17, 2023

Revised Multiple Myeloma International Staging System (R-ISS) – prognostication tool for myeloma patients based on…

Multiple Myeloma International Staging System (ISS) Online Calculator

January 16, 2023

Multiple Myeloma International Staging System (ISS) prognosticates the severity of multiple myeloma based on routinely…

Сообщение Maximum Allowable Blood Loss (ABL) Without Transfusion: Online calculator появились сначала на ClinCaseQuest.

IPSET – Thrombosis Risk for essential thrombocythemia: Online Calculator

Nataliia Lopina — Thu, 13 Jan 2022 16:09:57 +0000

International Prognostic Score of thrombosis in World Health Organization – essential thrombocythemia (IPSET-thrombosis).

IPSET-thrombosis model provides objective estimates of the probability of thrombotic events in patients with newly diagnosed ET.

The scale consist of the following parameters, listed below:

Patient age
• under 60 years	0
• 60 years or older	1
Prior thrombotic event	2
Cardiovascular risk factors present (One or more of: hypertension, diabetes mellitus, active smoking)	1
Detected JAK2 V617F mutation	2

The primary objective of essential thrombocythemia (ET) management is to prevent thromboembolic complications. In this regard, advanced age and thrombosis history were used to assess this risk. More recently, JAK2V617F and cardiovascular (CV) risk factors were identified as additional modifiers, leading to the development of a 3-tiered International Prognostic Score of Thrombosis for ET (IPSET-thrombosis): “low”, “intermediate”, and “high”.

Total 6 points (Age 1, H/O Thrombosis 2, Cardiovascular risk factor 1 and JAK2V617F – 2 points).

Determine risk group and prognosis:

Score	Risk category	Annual thrombosis risk
0 – 1	Low	1.03%
2	Intermediate	2.35%
3 – 6	High	3.56%

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Reference:
Barbui T, Finazzi G, Carobbio A, Thiele J, Passamonti F, Rumi E et al. Development and validation of an International Prognostic Score of thrombosis in World Health Organization-essential thrombocythemia (IPSET-thrombosis). Blood 2012; 12: 5128-33

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Follicular Lymphoma International Prognostic Index (FLIPI). Online calculator

Nataliia Lopina — Mon, 10 Jan 2022 09:27:11 +0000

Follicular Lymphoma International Prognostic Index (FLIPI) estimates overall survival based on clinical information.

FLIPI is designed to be used in patients with follicular lymphoma and to risk stratify patients based on prognosis. This can help guide when and how to treat such patients.

The FLIPI score was developed based on 4,167 patients with follicular lymphoma providing characteristics at diagnosis. Univariate and multivariate analyses were then used to develop a prognostic index. This was then validated in a cohort of 919 patients. Age, Ann Arbor stage, hemoglobin level, number of nodal areas, and serum LDH level were identified as adverse prognostic factors. The FLIPI was validated in a subsequent study and the performance improved by further stratifying age and including the presence of cerebrovascular disease.

The FLIPI, while a useful general prognostic tool, does not reliably predict those at diagnosis who will have an extremely rapid decline. Rather it assists with providing prognostic information. Ultimately, clinical judgement and comprehensive review of the patient’s previous workup are critical to make this assessment.

The GELF Criteria can help identify those patients with follicular lymphoma at higher risk for rapid disease progression and in whom immediate therapy may be needed.

The FLIPI score is easy to use with information most providers will already have available. Clinical evaluation, laboratory testing, and imaging are all that is needed to risk stratify patients and estimate prognosis.

Age > 60 years	No	0
	Yes	+1
>4 nodal sites See Nodal Sites* diagram*	No	0
	Yes	+1
LDH elevated	No	0
	Yes	+1
Hemoglobin <120 g/L or 12 g/dL	No	0
	Yes	+1
Stage III-IV Stage I: disease is located in a single region, usually one lymph node and the surrounding area. Stage II: disease is located in two separate regions, an affected lymph node or organ and a second affected area. Both affected areas are confined to one side of the diaphragm. Stage III: disease involves both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen. Stage IV: diffuse or disseminated involvement of one or more extranodal organs, with or without associated lymph node involvement. See Staging Diagram	No	0
	Yes	+1

Score Interpetation

Score	Risk Group	10-year Overall Survival
≤1	Low	70%
2	Intermediate	50%
≥3	High	35%

Useful Mnemonic – NoLash

Nodal areas
LDH
Age
Stage
Hemoglobin level

Nodal Sites

Staging Diagram

A FLIPI score of 0 to 1 is considered “low risk” with a 10 year overall survival of 70%. A score of 2 is considered “intermediate risk” with a 10 year overall survival of 50%. Finally, a score of ≥ 3 is considered “high risk” with a 10 year overall survival of 35%. Patients with an initial remission duration less than the median progression free survival for a particular treatment regimen and/or with a high FLIPI score are more likely to have a shorter remission duration.

Treatment is varied depending on the stage and tumor burden.

Stages I-II

Treatment options include:
- Involved field radiotherapy (IFRT)
- Clinical trials
- Active surveillance

Stages III-IV or Bulky stage II – asymptomatic

Treatment options include:
- Clinical trials
- Active surveillance

Stages III-IV or Bulky Stage II – with GELF/BNLI risk factors or high-risk FLIPI score

Treatment options include:
- Rituximab + cyclophosphamide, vincristine, doxorubicin, prednisone
- Rituximab alone
- Bendamustine + rituximab
- Rituximab + cyclophosphamide, vincristine, prednisone
- Clinical trials

There is continued controversy around when and how to treat follicular lymphoma, including in patients with relapsed/refractory disease. Questions to consider when making treatment decisions:

When to initiate therapy versus active surveillance
- Deciding amongst various treatment options
- Balancing efficacy and toxicities of treatment options
- Determining what constitutes a complete response/endpoint of treatment
Finally, with follicular lymphoma, a provider should be aware of transformation to diffuse large B-cell lymphoma, which is a more aggressive disease and would require prompt treatment.

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Literature:

Solal-Celigny et al. Follicular Lymphoma International Prognostic Index. Blood 104:1258-1265. (2004) https://pubmed.ncbi.nlm.nih.gov/15126323/
van de Schans SAM, et. al. Validation, revision and extension of the Follicular Lymphoma International Prognostic Index (FLIPI) in a population-based settingAnn Oncol (2009) 20 (10): 1697-1702 first published online June 23, 2009 doi:10.1093/annonc/mdp053 https://www.journals.elsevier.com/annals-of-oncology

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Multiple Myeloma Diagnostic Criteria – Online Calculator

≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)

Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator

R-ISS interpretation:

≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)

Multiple Myeloma International Staging System (ISS) Online Calculator

Multiple Myeloma ISS interpretation:

≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)

SAVED VTE Score

Calculation

≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)

IMPEDE VTE Score

Individual Risk Factors

Positive Factors

Negative Factors

Myeloma risk scores

Calculation

≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)

Checklist – Counseling “Explain a bone marrow aspiration”

Checklist – Counseling “History of Acute Intermittent Porphyria”

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Weight

Hemoglobin initial

Hemoglobin final (lowest acceptable hemoglobin, by clinical judgment units)

≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)

IPSET – Thrombosis Risk for essential thrombocythemia: Online Calculator

Follicular Lymphoma International Prognostic Index (FLIPI). Online calculator

Useful Mnemonic – NoLash

Nodal Sites

Staging Diagram