Anemia is an independent risk factor for adverse patient outcomes. There are no guidelines for management of anemia in patients with congestive heart failure (CHF), despite its high incidence. Four objectives were defined by the International Anemia Management and Clinical Outcomes Expert Panel (AMCO), a multinational group of interdisciplinary experts identified by the Society for the Advancement of Blood Management (SABM) to: determine the prevalence of anemia in outpatients; to determine the prevalence of hospital‐acquired anemia; to assess the impact of anemia management on clinical outcomes such as quality of life and functional status; and to provide recommendations for primary care physicians and specialists for the diagnosis, evaluation, and management of anemia in patients with CHF. Anemia and iron deficiency were confirmed to be highly prevalent in patients with CHF. Intravenous iron therapy improves anemia, cardiac function and exercise tolerance, leading to improvement in quality of life. Anemia management has been demonstrated to be cost‐effective. Clinical care pathways to manage anemia in patients with CHF are recommended as best practices in order to improve patient outcomes. Am. J. Hematol. 92:88–93, 2017. © 2016 Wiley Periodicals, Inc.

BACKGROUND Transfusions are common in hospitalized patients but carry significant risk, with associated morbidity and mortality that increases with each unit of blood received. Clinical trials consistently support a conservative over a liberal approach to transfusion. Yet there remains wide variation in practice, and more than half of red cell transfusions may be inappropriate. Adopting a more comprehensive approach to the bleeding, coagulopathic, or anemic patient has the potential to improve patient care. METHODS We present a patient‐centered blood management (PBM) paradigm. The 4 guiding principles of effective PBM that we present include anemia management, coagulation optimization, blood conservation, and patient‐centered decision making. RESULTS PBM has the potential to decrease transfusion rates, decrease practice variation, and improve patient outcomes. CONCLUSION PBM's value proposition is highly aligned with that of hospital medicine. Hospitalists' dual role as front‐line care providers and quality improvement leaders make them the ideal candidates to develop, implement, and practice PBM. Journal of Hospital Medicine 2014;9:60–65. © 2013 Society of Hospital Medicine

A 25 year-old woman with a history of atopic dermatitis presented to the emergency department with a generalized skin rash. She was at 12 weeks gestation in her first pregnancy. The skin lesions first appeared on her chest in an area where she had symptomatic eczema. These lesions were painful and diffuse, and were located on her face ( Figure 1A), trunk and extremities ( Figure 1B). The lesions consisted of crusted plaques and vesicles that drained clear fluid. Her body temperature was 101.1°F (38.4°C), her heart rate was 137 beats/min, and her leukocyte count was 11.8 Κ/μL (11.8 × 10 9 /L). Given her history of atopic dermatitis and diffuse vesicular lesions, we considered eczema herpeticum in the initial differential diagnosis and started acyclovir intravenously. Pelvic ultrasonography confirmed a 12-week-old viable intrauterine pregnancy. A Tzanck test from a skin scraping showed multinucleated giant epithelial cells. Levels of antibodies for herpes simplex virus (HSV) immunoglobulins M and G were elevated for HSV type 1.By day 4, the patient had been afebrile for 48 hours and her skin eruptions had improved. We changed treatment with acyclovir from intravenous to oral (200 mg five times daily) for a total of 10 days of treatment, and the patient was discharged home.Eczema herpeticum is a diffuse skin infection caused by HSV-1/2. It generally occurs in individuals with chronic skin disorders, such as atopic dermatitis. It can be spread by direct contact of susceptible skin with HSV or reactivated from previous infection. Immunosuppression and pregnancy may predispose patients to severe visceral dissemination of HSV that can spread rapidly and is associated with high mortality.1 Delayed diagnosis and treatment in women who are pregnant can lead to fulminant infection, which further increases risk of maternal death, preterm labour, neonatal HSV infection or fetal death.Acyclovir, valacyclovir and famciclovir have been used safely in the first trimester of pregnancy for infections caused by HSV.2 There are no controlled studies or current guidelines on managing this infection with antiviral agents in pregnant women; however, it appears safe to transition from intravenous to oral therapy when the skin rash improves and the patient has been afebrile for at least 48 hours. This article has been peer reviewed.The authors have obtained patient consent.

Our results suggest that layering multimodal interventions that involve both "hard-wired" changes to CPOE and education and performance feedback can result in decreased utilization of phlebotomy.