i-Build-a-Case: Diagnosing Acquired Hemophilia in Hospitalized Patients

0.6 ANCC Contact Hours 0.75 AMA PRA Category 1 Credit(s)
Launch Date:
November 21, 2013
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Hematologists, Hematologist/Oncologists, Pediatric Hematologist/Oncologists, Pediatric Hematologists, Surgeons, Anesthesiologists, Intensivists, Critical Care Medicine Specialists, Emergency Medicine Clinicians, Primary Care Physicians, Registered Nurses

Relevant Terms:

Acquired Hemophilia, Postpartum, Rare Bleeding Disorders

Aryeh Shander, MD, FCCM, FCCP

Aryeh Shander, MD, FCCM, FCCP
Clinical Professor of Anesthesiology, Medicine, and Surgery
Mount Sinai School of Medicine
Mount Sinai Hospital
New York, NY
Chief Executive Medical Director
Department of Anesthesiology, Critical Care Medicine, Pain Management, and Hyperbaric Medicine
Englewood Hospital and Medical Center
Englewood, NJ

Aryeh Shander, MD, FCCM, FCCP, is chief of the Department of Anesthesiology, Critical Care Medicine, and Hyperbaric Medicine at Englewood Hospital and Medical Center in New Jersey. He is also clinical professor of anesthesiology, medicine, and surgery at Mt. Sinai School of Medicine in New York City. Additional appointments include executive medical director of the Institute for Patient Blood Management and Bloodless Medicine and Surgery at Englewood Hospital and president of the medical/dental staff at Englewood Hospital and Medical Center. Dr. Shander received a medical degree from the University of Vermont College of Medicine in Burlington and completed an internship and residency in internal medicine at Montefiore Medical Center in Bronx, New York, where he also served as chief resident. Additional postgraduate training included a fellowship in critical care medicine and a residency in anesthesiology, both at Montefiore Medical Center. Dr. Shander is board certified in internal medicine, critical care, anesthesiology, and hyperbaric medicine.
Dr. Shander lectures nationally and internationally on a variety of topics related to anesthesiology, critical care medicine, and patient blood management. His published work has appeared in several prestigious peer-reviewed medical journals, including American Journal of Hematology, JAMA, Lancet, and Vox Sanguinis. Additionally, he is the author/editor of multiple book chapters and contributes to textbooks on blood management, such as Perioperative Transfusion Medicine (Lippincott Williams & Wilkins) and Perioperative Blood Management: A Physician's Handbook (American Association of Blood Banks). Dr. Shander is also a reviewer for the journals Critical Care Medicine, Anesthesia and Analgesia, and Transfusion, among others.
Active in numerous professional organizations, Dr. Shander serves as a board member, executive committee member, and president-elect of the Society for the Advancement of Blood Management, and is a fellow of the American College of Critical Care Medicine and the American College of Chest Physicians. He is also a founding member and treasurer of the American Society of Critical Care Anesthesiologists, for which he serves on committees both locally and nationally. In 1997, Dr. Shander was recognized by Time magazine as one of America's "Heroes of Medicine."
1. Interpret laboratory test results to correctly diagnose acquired hemophilia (AH)
2. Employ evidence-based treatment modalities to achieve hemostatic control and eradicate inhibitors in patients with AH
3. Provide appropriate counsel and education for patients and their families

Program Overview
Acquired hemophilia (AH) is a rare condition caused by the production of autoantibodies against factor VIII. Primarily a disease of the elderly, AH typically presents as extensive cutaneous purpura and internal hemorrhage. The condition can represent a diagnostic challenge to clinicians because in approximately 50% of cases, there is no identifiable underlying condition. Due to its rarity, AH is often not recognized or is mistaken for other acquired bleeding disorders such as disseminated intravascular coagulation. Delayed diagnosis or undertreated bleeds may place patients at risk for significant morbidity and mortality.

This interactive learning activity introduces clinicians to a rare acquired bleeding disorder they may not otherwise encounter in clinical practice. As they engage in building a case, they have the opportunity to learn from their choices, based on expert commentary about the diagnosis and management of AH.

Target Audience
This CME activity has been designed specifically to meet the educational needs of hospitalists, hematologists, HEM/ONCs, surgeons and anesthesiologists, intensivists and critical care medicine specialists, emergency medicine clinicians, primary care physicians, registered nurses, and other healthcare providers interested in managing hospitalized patients with bleeding disorders such as acquired hemophilia and unexplained bleeding due to a coagulation factor deficiency.

Estimated Time to Complete Activity
45 minutes

Course Viewing Requirements

Supported Browsers:
Internet Explorer 8.0+ for Windows 2000, 2003, Vista, XP, Windows 7, Windows 8
Google Chrome 28.0+ for Windows, Mac OS, or Linux
Mozilla Firefox 23.0+ for Windows, Mac OS, or Linux
Safari 5.0+ for Mac OSX 10.5 and above
Physician Continuing Medical Education
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Postgraduate Institute for Medicine, the Cardiovascular & Metabolic Health Foundation, and Educational Concepts in Medicine. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians. 

Credit Designation
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Education
Accreditation Statement
Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. 

Credit Designation
This educational activity for 0.6 ANCC contact hours is provided by Postgraduate Institute for Medicine (www.pimed.com).
Method of Participation
There are no fees for participating and receiving CME credit for this activity. During the period of November 21, 2013, through November 21, 2014, participants must:
  • Read the learning objectives and faculty disclosures
  • Study the educational activity
  • Complete the posttest by recording the best answer to each question
  • Complete the evaluation form
A statement of credit will be issued automatically upon successfully completing the posttest with a score of 70% or better.
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity: 
Name of Faculty or Presenter Reported Financial Relationship
Aryeh Shander, MD, FCCM, FCCP Consultant: AMAG Pharmaceuticals, Inc., Baxter, CSL Behring, Defense Advanced Research Projects Agency (DARPA), Deerfield Institute, Inc., Gauss Surgical, Masimo Corporation, New Jersey State District Attorney, Octapharma USA, OPK Biotech, LLC, ZymoGenetics, Inc.; Grant/Research: CSL Behring, Masimo Corporation, OPK Biotech, LLC, US Department of Defense, ZymoGenetics, Inc.; Speakers Bureau: American Regent, Baxter, CSL Behring, Masimo Corporation, Octapharma USA, ZymoGenetics
The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
Name of Planner or Manager Reported Financial Relationship
PIM Clinical Reviewers: Laura Excell, ND, NP, MS, MA, LPC, NCC; Trace Hutchison, PharmD; Samantha Mattiucci, PharmD, CCMEP; and Jan Schultz, RN, MSN, CCMEP Have no real or apparent conflicts of interest to report.
ECM: Patrick J. Crowley, MBA, Vice President/Managing Director; Cassie Rametta, BA, Program Director; Gay Boyle, MA, Chief Medical Writer Have no real or apparent conflicts of interest to report.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. 

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients' conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities. 
Fee Information
There is no fee for this educational activity.

Commercial Support
This activity is supported by an educational grant from Novo Nordisk Inc.