Browse the corpus

consistent with the policies of the ACP and the Hospital-Based Medicine Accreditation Council for Continuing Medical Education For the convenience ofsubscribers who provide care in (ACCME), contributors to all ACP continuing medical edu hospital settings, comprehensive hospital-focused content cation activities are required to disclose all relevant finan- aligned with the ABIM Focused Practice in Hospital Medicine cial relationships with any entify producing, marketing, blueprint is integrated throughout the syllabus, and self- re selling, or distributing health care goods or services con- assessment questions that are specific to the hospital setting sumed by, or used on, patients. Contributors are required to are specially designated with the blue hospitalist icon (E). use generic names in the discussion of therapeutic options and are required to identify any unapproved, off-label, or investigative use of commercial products or devices. Where High Value Care Key Points a trade name is used, all available trade names for the same Key Points in the text that relate to High Value Care concepts product type are also included. If trade name products (that is, concepts that discuss balancing clinical benefit with manufactured by companies with whom contributors have costs and harms) are designated by the HVC icon [HVC]. relationships are discussed, contributors are asked to pro vide evidence based citations in support ofthe discussion. The information is reviewed by the committee responsible Educational Disclaimer for producing this content. If necessary adjustments to The editors and publisher of MKSAP 19 recognize that the topics or contributors' roles in content development are development of new material offers many opportunities made to balance the discussion. All relevant relationships for error. Despite our best efforts, some errors may persist are mitigated. Readers of this content are asked to evaluate in print. Drug dosage schedules are, we believe, accurate it for evidence of commercial bias and send any relevant and in accordance with current standards. Readers are comments to mksap-editors6lacponline.org so that future advised, however, to ensure that the recommended dos- decisions about content and contributors can be made in ages in MKSAP 19 concur with the information provided light of this information. in the product information material. This is especially important in cases of ner.r,, infrequently used, or highly toxic drugs. Application of the information in MKSAP 19 Mitigation of Conflicts remains the professional responsibility of the practitioner. To mitigate all conflicts of interest and influences of vested interests, ACP's content planners used best evidence and The primary purpose of MKSAP 19 is educational. updated clinical care guidelines in developing content, Information presented, as well as publications, technol- when such evidence and guidelines were available. A11 ogies, products, and/or services discussed, is intended to content underwent review by external peer revie\ ers not inform subscribers about the knowledge, techniques, and on the committee to ensure that the material was bal experiences of the contributors. A diversity of professional anced and unbiased. Contributors' disclosure information opinion exists, and the views of the contributors are their can be found with the list of contributors' names and own and not those of the ACP. Inclusion of any material in those of ACP principal staff listed in the beginning of the program does not constitute endorsement or recom- this book. mendation by the ACP The ACP does not warrant the safety, reliability, accuracy, completeness, or usefulness of and dis- claims any and all liability for damages and claims that may Language Reflecting Diversity, Equity, result from the use of information, publications, technolo- and lnclusion within MKSAP 19 gies, products, and/or services discussed in this program. MKSAP 19's Editors and contributors commit to using Ianguage and images that support ACP's commitment to Publisher's lnformation being an anti racist organization that supports diversity, Copyright ,r 2022 American College of Physicians. All equiry and inclusion throughout health care and health rights reserved. education. ACP also continues to ensure diversity among MKSAP's physician-contributors. When appropriate, This publication is protected by copyright. No part of the MKSAP Editors will also rely on MKSAP 19 Digital's this publication may be reproduced, stored in a retrieval expanded use of multimedia enhancements, including video system, or transmitted in any form or by any means, elec- and audio, to explore and more fully explain issues sur- tronic or mechanical, including photocopy, without the rounding the presentation of MKSAP 19 clinical content as it express consent of the ACP. MKSAP 19 is for individual relates to race and ethnicity. MKSAP 19 users are encouraged use only. Only one account per subscription will be per to contact the Editors at mksap_editorspacponline.org to mitted for the purpose of earning CME credits and MOC help us identif,i opportunities for improvement in this area. points and for other authorized uses of MKSAP 19.

consistent with the policies of the ACP and the Hospital-Based Medicine Accreditation Council for Continuing Medical Education For the convenience ofsubscribers who provide care in (ACCME), contributors to all ACP continuing medical edu hospital settings, comprehensive hospital-focused content cation activities are required to disclose all relevant finan- aligned with the ABIM Focused Practice in Hospital Medicine cial relationships with any entify producing, marketing, blueprint is integrated throughout the syllabus, and self- re selling, or distributing health care goods or services con- assessment questions that are specific to the hospital setting sumed by, or used on, patients. Contributors are required to are specially designated with the blue hospitalist icon (E). use generic names in the discussion of therapeutic options and are required to identify any unapproved, off-label, or investigative use of commercial products or devices. Where High Value Care Key Points a trade name is used, all available trade names for the same Key Points in the text that relate to High Value Care concepts product type are also included. If trade name products (that is, concepts that discuss balancing clinical benefit with manufactured by companies with whom contributors have costs and harms) are designated by the HVC icon [HVC]. relationships are discussed, contributors are asked to pro vide evidence based citations in support ofthe discussion. The information is reviewed by the committee responsible Educational Disclaimer for producing this content. If necessary adjustments to The editors and publisher of MKSAP 19 recognize that the topics or contributors' roles in content development are development of new material offers many opportunities made to balance the discussion. All relevant relationships for error. Despite our best efforts, some errors may persist are mitigated. Readers of this content are asked to evaluate in print. Drug dosage schedules are, we believe, accurate it for evidence of commercial bias and send any relevant and in accordance with current standards. Readers are comments to mksap-editors6lacponline.org so that future advised, however, to ensure that the recommended dos- decisions about content and contributors can be made in ages in MKSAP 19 concur with the information provided light of this information. in the product information material. This is especially important in cases of ner.r,, infrequently used, or highly toxic drugs. Application of the information in MKSAP 19 Mitigation of Conflicts remains the professional responsibility of the practitioner. To mitigate all conflicts of interest and influences of vested interests, ACP's content planners used best evidence and The primary purpose of MKSAP 19 is educational. updated clinical care guidelines in developing content, Information presented, as well as publications, technol- when such evidence and guidelines were available. A11 ogies, products, and/or services discussed, is intended to content underwent review by external peer revie\ ers not inform subscribers about the knowledge, techniques, and on the committee to ensure that the material was bal experiences of the contributors. A diversity of professional anced and unbiased. Contributors' disclosure information opinion exists, and the views of the contributors are their can be found with the list of contributors' names and own and not those of the ACP. Inclusion of any material in those of ACP principal staff listed in the beginning of the program does not constitute endorsement or recom- this book. mendation by the ACP The ACP does not warrant the safety, reliability, accuracy, completeness, or usefulness of and dis- claims any and all liability for damages and claims that may Language Reflecting Diversity, Equity, result from the use of information, publications, technolo- and lnclusion within MKSAP 19 gies, products, and/or services discussed in this program. MKSAP 19's Editors and contributors commit to using Ianguage and images that support ACP's commitment to Publisher's lnformation being an anti racist organization that supports diversity, Copyright ,r 2022 American College of Physicians. All equiry and inclusion throughout health care and health rights reserved. education. ACP also continues to ensure diversity among MKSAP's physician-contributors. When appropriate, This publication is protected by copyright. No part of the MKSAP Editors will also rely on MKSAP 19 Digital's this publication may be reproduced, stored in a retrieval expanded use of multimedia enhancements, including video system, or transmitted in any form or by any means, elec- and audio, to explore and more fully explain issues sur- tronic or mechanical, including photocopy, without the rounding the presentation of MKSAP 19 clinical content as it express consent of the ACP. MKSAP 19 is for individual relates to race and ethnicity. MKSAP 19 users are encouraged use only. Only one account per subscription will be per to contact the Editors at mksap_editorspacponline.org to mitted for the purpose of earning CME credits and MOC help us identif,i opportunities for improvement in this area. points and for other authorized uses of MKSAP 19. vl

Disclaimer Regarding Direct Purchases ACP will consider granting an individual permission to from Online Retailers reproduce only limited portions of this publication for his or her own exclusive use. Send requests in writing to CME and/or MOC for MKSAP 19 is available only to MKSAP@ Permissions, American College of Physicians, customers who purchase the program directly from 190 N. Independence Mall West, Philadelphia, P A19106-1572, ACP. ACP will not set up MKSAP CME/MOC accounts or email your request to mksap_editors6racponline.org. for purchasers of MKSAP sold by unauthorized sellers (e.g., Amazon, eBay), with whom ACP has no relation- MKSAP 19 ISBN: 978-l-93824s-7s-6 ship. We do not honor third party sales. CME credits Hematology ISBN: 978-1-938245-85-5 and MOC points cannot be awarded to those purchasers Printed in the United States of America. who have purchased the program from non-authorized sellers. For order information in the U.S. or Canada, call 8OO ACP 1915. In all other countries, call 215-351-2600 (Monday to Friday, 9 AM-s prr,I ET). Fax inquiries to 215-351-2799 or email to custserv@acponline.org. Unauthorized Use of This Book ls Againstthe Law Unauthorized reproduction of this publication is unlawful. Errata and Revisions ACP prohibits reproduction ofthis publication or any of Errata and Revisions for MKSAP 19 will be available its parts in any form either for individual use or for through MKSAP 19 Digital at mksapl9.acponline.org as distribution. new information becomes known to the editors. l vlt