Pearls from 8/10/21 Medicine LEADS

Thursday, August 12, 2021

The August 10, 2021 session of Duke Medicine LEADS featured a discussion led by Ryan Duffy, MD; Hannah Florian, MD; and Matthew Abbott, MD, "A Challenging Case of Jaundice and Pancytopenia."

Panelist included, Louis Diehl, MD; Lawrence Mumm, MD; and Endi Wang, MD, PhD, who weighed in for the diagnostic reasoning discussion.

Here are pearls and takeaways from the session:

  1. HLH is a life-threatening inflammatory disorder that can occur as a familial or sporadic disorder.

  2. The major barrier to good outcomes is delay in diagnosis. The H-score is a clinical tool that can estimate a patient's probability of having HLH.

  3. Adults with no obvious immune trigger need a thorough malignancy workup. Idiopathic HLH carries a poor prognosis.

  4. Treatment of HLH depends on severity of disease and the immune trigger, but will often involve immunosuppression. 

  5. Framework for goals of care discussion: 1.) Understanding of prognosis and situation 2.) Based on the prognosis what is most important to focus on 3.) What interventions give us the best chance to achieve those goals. 

  6. COVID-19 has exacerbated disparities related to end-of -life and family centered care. Interventions to improve communication include: speaker phones during rounds, utilization of our chaplains, identifying a family point person, and providing patients with charging equipment. 

​Watch the recorded session

Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.