What is the follow-up plan for a patient with improved Gastroesophageal Reflux Disease (GERD) symptoms and persistent leukopenia, who is already established with a hematology (blood disorder) specialist?

From the Guidelines

The patient's persistent leukopenia requires urgent follow-up with a hematologist within 24 to 72 hours, as per the American Society of Hematology 2019 guidelines for immune thrombocytopenia 1. The patient came for a one-week follow-up regarding GERD symptoms, which have significantly improved with treatment. However, the patient has persistent leukopenia (low white blood cell count) and is already established with hematology. The clinic's referral clerk, Tiffany, contacted the hematology department and faxed the patient's lab results.

• The patient's understanding and agreement to follow up with the hematology department are crucial for ensuring continuity of care.
• The hematology department's plan to reach out to schedule a follow-up appointment is a good practice, as it ensures the patient receives timely specialized monitoring and management for their leukopenia.
• It is essential to prioritize the patient's hematological concern, given the potential risks associated with persistent leukopenia, such as increased susceptibility to infections.
• The American Society of Hematology 2019 guidelines for immune thrombocytopenia 1 emphasize the importance of prompt follow-up with a hematologist, which is applicable to this patient's situation, despite the specific diagnosis of leukopenia.
• The patient's improving GERD symptoms are a positive outcome, but the ongoing hematological concern takes precedence in terms of requiring urgent attention and management.

From the Research

Patient Follow-up and GERD Symptoms

• The patient reported an improvement in GERD symptoms, which is a primary aim in treating patients with symptomatic GERD 2.
• The patient's symptoms, such as heartburn and acid regurgitation, are expected to improve with active treatment, and epigastric pain and other upper GI symptoms usually improve as well 2.
• Lifestyle changes are crucial in the treatment of GERD, and individual variations can be seen in how GERD symptoms change in response to different diets 3.

Leukopenia and Hematology Follow-up

• The patient has persistent leukopenia and is established with hematology, and the referrals clerk has faxed the labs to hematology and they will contact the patient for follow-up appointment 4, 5.
• Filgrastim, a recombinant human granulocyte colony-stimulating factor (G-CSF), has been evaluated in the treatment of patients with various neutropenic conditions, and it principally stimulates activation, proliferation, and differentiation of neutrophil progenitor cells 4.
• Pegfilgrastim, a long-acting form of filgrastim, has been developed to eliminate the burden of daily filgrastim injection and has received marketing authorization approval to reduce the incidence of chemotherapy-induced neutropenia 5.

Treatment and Management

• Proton pump inhibitors (PPIs) are the most effective medical therapy for GERD, and all PPIs provide similar relief of GERD symptoms 6.
• There is insufficient evidence to recommend testing for H. pylori in patients with GERD, and endoscopy is not necessary to make an initial diagnosis of GERD in the absence of alarm symptoms 6.
• Screening for Barrett esophagus is not routinely recommended, but may be considered in white men 50 years or older who have had GERD symptoms for at least five years 6.