Bio

Bio


Dr. Shah is board certified in clinical pathology, transfusion medicine, and clinical informatics. His interests include the creation and use of rules-based and machine learning models from health data to help providers make better care decisions.

Clinical Focus


  • Blood Transfusion
  • Medical Informatics
  • Clinical Laboratory Information Systems
  • Clinical Pathology

Academic Appointments


  • Clinical Associate Professor, Pathology

Administrative Appointments


  • Medical Director of Informatics for Transfusion Services, Stanford University Medical Center (2013 - Present)
  • Medical Director of Referral (Send Out) Testing, Stanford University Medical Center (2013 - 2019)
  • Medical Informatics Director, Stanford Healthcare (2014 - Present)

Professional Education


  • Board Certification: Clinical Pathology, American Board of Pathology (2013)
  • Medical Education:University of Texas Southwestern Medical School Registrar (2009) TX
  • Board Certification: Clinical Informatics, American Board of Pathology (2016)
  • Board Certification: Blood Banking/Transfusion Medicine, American Board of Pathology (2013)
  • Residency:University of Texas Sourthwestern Medical Center (2009) TX
  • Fellowship:University of Texas Sourthwestern Medical Center (2013) TX
  • B.S., Duke University, Biochemistry, Health Policy (2005)

Teaching

Graduate and Fellowship Programs


Publications

All Publications


  • Decision Support in Transfusion Medicine and Blood Banking CLINICS IN LABORATORY MEDICINE Shah, N. K. 2019; 39 (2): 269-+
  • Decision Support in Transfusion Medicine and Blood Banking. Clinics in laboratory medicine Shah, N. K. 2019; 39 (2): 269?79

    Abstract

    Clinical decision support (CDS) can greatly enhance patient blood management through optimizing ordering and providing patient-specific information. At present, modeling and prediction have small roles in inventory management; they will likely have increasing applications to help guide donor center collections based on real-time demand to meet more dispersed needs. Transfusion side-effects management for both donor and recipients is an area ripe for intervention by CDS to enable proactive actions. Last, CDS and broader prediction will 1 day function alongside and seamlessly along many of our major processes to create a human-computer symbiosis.

    View details for PubMedID 31036280

  • Thrombophilia testing in the inpatient setting: impact of an educational intervention. BMC medical informatics and decision making Kwang, H., Mou, E., Richman, I., Kumar, A., Berube, C., Kaimal, R., Ahuja, N., Harman, S., Johnson, T., Shah, N., Witteles, R., Harrington, R., Shieh, L., Hom, J. 2019; 19 (1): 167

    Abstract

    Thrombophilia testing is frequently ordered in the inpatient setting despite its limited impact on clinical decision-making and unreliable results in the setting of acute thrombosis or ongoing anticoagulation. We sought to determine the effect of an educational intervention in reducing inappropriate thrombophilia testing for hospitalized patients.During the 2014 academic year, we implemented an educational intervention with a phase implementation design for Internal Medicine interns at Stanford University Hospital. The educational session covering epidemiology, appropriate thrombophilia evaluation and clinical rationale behind these recommendations. Their ordering behavior was compared with a contemporaneous control (non-medicine and private services) and a historical control (interns from prior academic year). From the analyzed data, we determined the proportion of inappropriate thrombophilia testing of each group. Logistic generalized estimating equations were used to estimate odds ratios for inappropriate thrombophilia testing associated with the intervention.Of 2151 orders included, 934 were deemed inappropriate (43.4%). The two intervention groups placed 147 orders. A pooled analysis of ordering practices by intervention groups revealed a trend toward reduction of inappropriate ordering (p=?0.053). By the end of the study, the intervention groups had significantly lower rates of inappropriate testing compared to historical or contemporaneous controls.A brief educational intervention was associated with a trend toward reduction in inappropriate thrombophilia testing. These findings suggest that focused education on thrombophilia testing can positively impact inpatient ordering practices.

    View details for DOI 10.1186/s12911-019-0889-6

    View details for PubMedID 31429747

  • Predicting Low Information Laboratory Diagnostic Tests. AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science Roy, S. K., Hom, J., Mackey, L., Shah, N., Chen, J. H. 2018; 2017: 217?26

    Abstract

    Escalating healthcare costs and inconsistent quality is exacerbated by clinical practice variability. Diagnostic testing is the highest volume medical activity, but human intuition is typically unreliable for quantitative inferences on diagnostic performance characteristics. Electronic medical records from a tertiary academic hospital (2008-2014) allow us to systematically predict laboratory pre-test probabilities of being normal under different conditions. We find that low yield laboratory tests are common (e.g., ~90% of blood cultures are normal). Clinical decision support could triage cases based on available data, such as consecutive use (e.g., lactate, potassium, and troponin are >90% normal given two previously normal results) or more complex patterns assimilated through common machine learning methods (nearly 100% precision for the top 1% of several example labs).

    View details for PubMedID 29888076

  • Real-Time Clinical Decision Support Decreases Inappropriate Plasma Transfusion AMERICAN JOURNAL OF CLINICAL PATHOLOGY Shah, N., Baker, S. A., Spain, D., Shieh, L., Shepard, J., Hadhazy, E., Maggio, P., Goodnough, L. T. 2017; 148 (2): 154?60

    Abstract

    To curtail inappropriate plasma transfusions, we instituted clinical decision support as an alert upon order entry if the patient's recent international normalized ratio (INR) was 1.7 or less.The alert was suppressed for massive transfusion and within operative or apheresis settings. The plasma order was automatically removed upon alert acceptance while clinical exception reasons allowed for continued transfusion. Alert impact was studied comparing a 7-month control period with a 4-month intervention period.Monthly plasma utilization decreased 17.4%, from a mean SD of 3.40 0.48 to 2.82 0.6 plasma units per hundred patient days (95% confidence interval [CI] of difference, -0.1 to 1.3). Plasma transfused below an INR of 1.7 or less decreased from 47.6% to 41.6% (P = .0002; odds ratio, 0.78; 95% CI, 0.69-0.89). The alert recommendation was accepted 33% of the time while clinical exceptions were chosen in the remaining cases (active bleeding, 31%; other clinical indication, 33%; and apheresis, 2%). Alert acceptance rate varied significantly among different provider specialties.Clinical decision support can help curtail inappropriate plasma use but needs to be part of a comprehensive strategy including audit and feedback for comprehensive, long-term changes.

    View details for PubMedID 28898990

  • Implementation of Epic Beaker Clinical Pathology at Stanford University Medical Center AMERICAN JOURNAL OF CLINICAL PATHOLOGY Tan, B. T., Fralick, J., Flores, W., Schrandt, C., Davis, V., Bruynell, T., Wilson, L., Christopher, J., Weber, S., Shah, N. 2017; 147 (3): 261-272

    Abstract

    To provide an account of implementation of the Epic Beaker 2014 clinical pathology module at Stanford University Medical Center and highlight strengths and weaknesses of the system.Based on a formal selection process, Stanford selected Epic Beaker to replace Sunquest as the clinical laboratory information system (LIS). The rationale included integration between the LIS and already installed Epic electronic medical record (EMR), reduction in the number of systems and interfaces, and positive patient identification (PPID). The build was significantly customized and included a first of its kind Epic-to-Epic interface. This was due to the clinical laboratory serving two hospitals (pediatric and adult) with independent instances of Epic.Test turnaround times showed improvement from historical baselines, mostly because of the implementation of PPID. PPID also resulted in significant reduction in mislabeled specimens.Epic 2014 Beaker clinical pathology is a viable LIS with adequate functionality for a large academic center. Strengths include PPID and integration with the EMR. Integration provides laboratory users with ready access to the patient's relevant clinical history to assist releasing of results and gives physician and nurse providers sophisticated add-on ordering and specimen collection workflows. Areas that could use further development include specimen aliquoting, quality control reporting, and maintenance tools.

    View details for DOI 10.1093/AJCP/AQW221

    View details for Web of Science ID 000397109200002

    View details for PubMedID 28395051

  • A high value care curriculum for interns: a description of curricular design, implementation and housestaff feedback. Postgraduate medical journal Hom, J., Kumar, A., Evans, K. H., Svec, D., Richman, I., Fang, D., Smeraglio, A., Holubar, M., Johnson, T., Shah, N., Renault, C., Ahuja, N., Witteles, R., Harman, S., Shieh, L. 2017

    Abstract

    Most residency programmes do not have a formal high value care curriculum. Our goal was to design and implement a multidisciplinary high value care curriculum specifically targeted at interns.Our curriculum was designed with multidisciplinary input from attendings, fellows and residents at Stanford. Curricular topics were inspired by the American Board of Internal Medicine's Choosing Wisely campaign, Alliance for Academic Internal Medicine, American College of Physicians and Society of Hospital Medicine. Our topics were as follows: introduction to value-based care; telemetry utilisation; lab ordering; optimal approach to thrombophilia work-ups and fresh frozen plasma use; optimal approach to palliative care referrals; antibiotic stewardship; and optimal approach to imaging for low back pain. Our curriculum was implemented at the Stanford Internal Medicine residency programme over the course of two academic years (2014 and 2015), during which 100 interns participated in our high value care curriculum. After each high value care session, interns were offered the opportunity to complete surveys regarding feedback on the curriculum, self-reported improvements in knowledge, skills and attitudinal module objectives, and quiz-based knowledge assessments.The overall survey response rate was 67.1%. Overall, the material was rated as highly useful on a 5-point Likert scale (mean 4.4, SD 0.6). On average, interns reported a significant improvement in their self-rated knowledge, skills and attitudes after the six seminars (mean improvement 1.6 points, SD 0.4 (95% CI 1.5 to 1.7), p<0.001).We successfully implemented a novel high value care curriculum that specifically targets intern physicians.

    View details for PubMedID 28663352

  • Assessing Screening Guidelines for Cardiovascular Disease Risk Factors using Routinely Collected Data. Scientific reports Pannu, J., Poole, S., Shah, N., Shah, N. H. 2017; 7 (1): 6488

    Abstract

    This study investigates if laboratory data can be used to assess whether physician-retesting patterns are in line with established guidelines, and if these guidelines identify deteriorating patients in a timely manner. A total of 7594 patients with high cholesterol were studied, along with 2764 patients with diabetes. More than 90% of borderline high cholesterol patients are retested within the 3 year recommended period, however less than 75% of pre-diabetic patients have repeated tests within the suggested 1-year time frame. Patients with borderline high cholesterol typically progress to full high cholesterol in 2-3 years, and pre-diabetic patients progress to full diabetes in 1-2 years. Data from routinely ordered laboratory tests can be used to monitor adherence to clinical guidelines. These data may also be useful in the design of adaptive testing strategies that reduce unnecessary testing, while ensuring that patient deterioration is identified in a timely manner. Established guidelines for testing of total serum cholesterol for hypercholesterolemia are appropriate and are well-adhered to, whereas guidelines for glycated hemoglobin A1c testing for type 2 diabetes mellitus could be improved to bring them in line with current practice and avoid unnecessary testing.

    View details for PubMedID 28747722

  • How I use clinical decision support to improve red blood cell utilization TRANSFUSION Goodnough, L. T., Baker, S. A., Shah, N. 2016; 56 (10): 2406-2411

    Abstract

    Despite 20 years of published medical society guidelines for blood transfusion and a pivotal clinical trial in 1999 providing Level 1 evidence that restrictive transfusion practices can be utilized safely, blood transfusions did not begin to decline in the United States until 2010. Widespread adoption of electronic medical records allowed implementation of computerized systems such as clinical decision support (CDS) with best practice alerts to improve blood utilization. We describe our own experience using well-designed and highly targeted CDS to promote restrictive transfusion practices and improve red blood cell utilization, with a 42% reduction in blood transfusions from 2009 through 2015, accompanied by improved clinical outcomes.

    View details for DOI 10.1111/trf.13767

    View details for Web of Science ID 000385834800004

  • How I use clinical decision support to improve red blood cell utilization. Transfusion Tim Goodnough, L., Andrew Baker, S., Shah, N. 2016; 56 (10): 2406-2411

    Abstract

    Despite 20 years of published medical society guidelines for blood transfusion and a pivotal clinical trial in 1999 providing Level 1 evidence that restrictive transfusion practices can be utilized safely, blood transfusions did not begin to decline in the United States until 2010. Widespread adoption of electronic medical records allowed implementation of computerized systems such as clinical decision support (CDS) with best practice alerts to improve blood utilization. We describe our own experience using well-designed and highly targeted CDS to promote restrictive transfusion practices and improve red blood cell utilization, with a 42% reduction in blood transfusions from 2009 through 2015, accompanied by improved clinical outcomes.

    View details for DOI 10.1111/trf.13767

    View details for PubMedID 27546388

  • Transportation Cooler Interventions Reduce Plasma and RBC Product Wastage. American journal of clinical pathology Metcalf, R. A., Baker, S. A., Goodnough, L. T., Shah, N. 2016; 146 (1): 18-24

    Abstract

    The rate of plasma product wastage for the United States in 2011 was approximately 1.8%. The plasma wastage rate at our institution was higher, mainly due to products returned out of temperature range from procedural areas. A process review and intervention to reduce plasma wastage was undertaken, which included modifications to our transport cooler.A new cooler system was designed, and this device was implemented alongside an updated protocol for delivering plasma while also enhancing the previous RBC cooler validation time. We audited plasma and RBC product wastage prior to these interventions, from January 2013 to February 2014, vs after the intervention from April 2014 to March 2015.After the intervention, the monthly plasma wastage rate declined 60% (12.6 units/100 units transfused preintervention vs 5.0 units/100 units transfused postintervention; P?

    View details for DOI 10.1093/ajcp/aqw082

    View details for PubMedID 27357292

  • Is there a "magic" hemoglobin number? Clinical decision support promoting restrictive blood transfusion practices. American journal of hematology Goodnough, L. T., Shah, N. 2015; 90 (10): 927-933

    Abstract

    Blood transfusion has been identified as one of the most frequently performed therapeutic procedures, with a significant percentage of transfusions identified to be inappropriate. Recent key clinical trials in adults have provided Level 1 evidence to support restrictive red blood cell (RBC) transfusion practices. However, some advocates have attempted to identify a "correct" Hb threshold for RBC transfusion; whereas others assert that management of anemia, including transfusion decisions, must take into account clinical patient variables, rather than simply one diagnostic laboratory test. The heterogeneity of guidelines for blood transfusion by a number of medical societies reflects this controversy. Clinical decision support (CDS) uses a Hb threshold number in a smart Best Practices Alert (BPA) upon physician order, to trigger a concurrent utilization self-review for whether blood transfusion therapy is appropriate. This review summarizes Level 1 evidence in seven key clinical trials in adults that support restrictive transfusion practices, along strategies made possible by CDS that have demonstrated value in improving blood utilization by promoting restrictive transfusion practices. Am. J. Hematol. 90:927-933, 2015. 2015 Wiley Periodicals, Inc.

    View details for DOI 10.1002/ajh.24101

    View details for PubMedID 26113442

  • Transfusions for anemia in adult and pediatric patients with malignancies. Blood reviews Shah, N., Andrews, J., Goodnough, L. T. 2015; 29 (5): 291-299

    Abstract

    Anemia is present in over two-thirds of patients with malignant hematological disorders. The etiology of anemia predominates from ineffective erythropoiesis from marrow infiltration, cytokine related suppression, erythropoietin suppression, and vitamin deficiency; ineffective erythropoiesis is further exacerbated by accelerated clearance due to antibody mediated hemolysis and thrombotic microangiopathy. As the anemia is chronic in nature, symptoms are generally well tolerated and often non-specific. Transfusion of red blood cells (RBCs) is a balance between providing benefit for patients while avoiding risks of transfusion. Conservative/restrictive RBC transfusion practices have shown equivalent patient outcomes compared to liberal transfusion practices, and meta-analysis has shown improved in-hospital mortality, reduced cardiac events, re-bleeding, and bacterial infections. The implications for a lower threshold for transfusion in patients with malignancies are therefore increasingly being scrutinized. Alternative management strategies for anemia with IV iron and erythropoietin stimulating agents (ESAs) should be considered in the appropriate settings.

    View details for DOI 10.1016/j.blre.2015.02.001

    View details for PubMedID 25796130

  • The Next Chapter in Patient Blood Management Real-Time Clinical Decision Support AMERICAN JOURNAL OF CLINICAL PATHOLOGY Goodnough, L. T., Shah, N. 2014; 142 (6): 741-747

    Abstract

    Blood transfusion was identified by the American Medical Association as one of the top five most frequently overused therapies. Utilization review has been required by accreditation agencies, but retrospective review has been ineffective due to labor-intense resources applied to only a sampling of transfusion events. Electronic medical records have allowed clinical decision support (CDS) to occur via a best practices alert at the critical decision point concurrently with physician order entry.We review emerging strategies for improving blood utilization.Implementation of CDS at our institution decreased the percentage of transfusions in patients with a hemoglobin level of more than 8 g/dL from 60% to less than 30%. Annual RBC transfusions were reduced by 24%, despite concurrent increases in patient discharge volumes and case mix complexity. This resulted in acquisition costs savings (direct blood product purchase costs) of $6.4 million over 4 years.We have been able to significantly reduce inappropriate blood transfusions and related costs through an educational initiative coupled with real-time CDS. In deriving increased value out of health care, CDS can be applied to a number of overuse measures in laboratory testing, radiology, and therapy such as antibiotics, as outlined by the American Board of Internal Medicine's Choosing Wisely campaign.

    View details for DOI 10.1309/AJCP4W5CCFOZUJFU

    View details for Web of Science ID 000345053900004

  • The next chapter in patient blood management: real-time clinical decision support. American journal of clinical pathology Goodnough, L. T., Shah, N. 2014; 142 (6): 741-747

    Abstract

    Blood transfusion was identified by the American Medical Association as one of the top five most frequently overused therapies. Utilization review has been required by accreditation agencies, but retrospective review has been ineffective due to labor-intense resources applied to only a sampling of transfusion events. Electronic medical records have allowed clinical decision support (CDS) to occur via a best practices alert at the critical decision point concurrently with physician order entry.We review emerging strategies for improving blood utilization.Implementation of CDS at our institution decreased the percentage of transfusions in patients with a hemoglobin level of more than 8 g/dL from 60% to less than 30%. Annual RBC transfusions were reduced by 24%, despite concurrent increases in patient discharge volumes and case mix complexity. This resulted in acquisition costs savings (direct blood product purchase costs) of $6.4 million over 4 years.We have been able to significantly reduce inappropriate blood transfusions and related costs through an educational initiative coupled with real-time CDS. In deriving increased value out of health care, CDS can be applied to a number of overuse measures in laboratory testing, radiology, and therapy such as antibiotics, as outlined by the American Board of Internal Medicine's Choosing Wisely campaign.

    View details for DOI 10.1309/AJCP4W5CCFOZUJFU

    View details for PubMedID 25389326

  • Restrictive blood transfusion practices are associated with improved patient outcomes. Transfusion Goodnough, L. T., Maggio, P., Hadhazy, E., Shieh, L., Hernandez-Boussard, T., Khari, P., Shah, N. 2014; 54 (10): 2753-2759

    Abstract

    Blood transfusion has been cited as one of the five most overutilized therapeutic procedures in the United States. We assessed the impact of clinical decision support at computerized physician order entry and education on red blood cell (RBC) transfusions and clinical patient outcomes at our institution.Clinical patient outcomes and RBC transfusions were assessed before and after implementation of a best practice alert triggered for transfusions when the hemoglobin level was higher than 7?g/dL for all inpatient discharges from January 2008 through December 2013. Retrospective clinical and laboratory data related to RBC transfusions were extracted: case-mix complexity, patient discharges and selected surgical volumes, and patient outcomes (mortality, 30-day readmissions, length of stay).There was a significant improvement in RBC utilization as assessed by RBC units transfused per 100 patient-days-at-risk. Concurrently, hospital-wide clinical patient outcomes showed improvement (mortality, p?=?0.034; length of stay, p?=?0.003) or remained stable (30-day readmission rates, p?=?0.909). Outcome improvements were even more pronounced in patients who received blood transfusions, with decreased mortality rate (55.2 to 33.0, p?

    View details for DOI 10.1111/trf.12723

    View details for PubMedID 24995770

  • Restrictive blood transfusion practices are associated with improved patient outcomes TRANSFUSION Goodnough, L. T., Maggio, P., Hadhazy, E., Shieh, L., Hernandez-Boussard, T., Khari, P., Shah, N. 2014; 54 (10): 2753-2759

    Abstract

    Blood transfusion has been cited as one of the five most overutilized therapeutic procedures in the United States. We assessed the impact of clinical decision support at computerized physician order entry and education on red blood cell (RBC) transfusions and clinical patient outcomes at our institution.Clinical patient outcomes and RBC transfusions were assessed before and after implementation of a best practice alert triggered for transfusions when the hemoglobin level was higher than 7?g/dL for all inpatient discharges from January 2008 through December 2013. Retrospective clinical and laboratory data related to RBC transfusions were extracted: case-mix complexity, patient discharges and selected surgical volumes, and patient outcomes (mortality, 30-day readmissions, length of stay).There was a significant improvement in RBC utilization as assessed by RBC units transfused per 100 patient-days-at-risk. Concurrently, hospital-wide clinical patient outcomes showed improvement (mortality, p?=?0.034; length of stay, p?=?0.003) or remained stable (30-day readmission rates, p?=?0.909). Outcome improvements were even more pronounced in patients who received blood transfusions, with decreased mortality rate (55.2 to 33.0, p?

    View details for DOI 10.1111/trf.12723

    View details for Web of Science ID 000343821100023

  • Role of ADAMTS13 in the management of thrombotic microangiopathies including thrombotic thrombocytopenic purpura (TTP) BRITISH JOURNAL OF HAEMATOLOGY Shah, N., Rutherford, C., Matevosyan, K., Shen, Y., Sarode, R. 2013; 163 (4): 514-519

    Abstract

    The clinical presentation of thrombotic thrombocytopenia purpura (TTP) and other thrombotic microangiopathies (TMAs) can often be similar. The role of a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13) in diagnosing TTP is accepted by most researchers but continues to be debated in a few studies. We report the experience of our single-centre academic institution, where ADAMTS13 is used to diagnose TTP and guide plasma exchange (PLEX). Patients presenting to our institution with thrombotic microangiopathy (60 patients) between January 2006 and December 2012 were divided into two groups based on ADAMTS13 activity and clinical history. Patients with ADAMTS13 activity <10% were included in the TTP (n = 30) cohort while patients with activity >11% were classified as 'other microangiopathies' (TMA, n = 30). PLEX was only initiated in patients with a high likelihood of TTP and discontinued when the baseline ADAMTS13 activity was >11%. Patients with severe ADAMTS13 deficiency (TTP group) showed significant presenting differences: lower platelet counts, less renal dysfunction, higher presence of neurological abnormalities, and greater haemolysis markers as compared to non-deficient patients (TMA group). Most importantly, patients without severe ADAMTS13 deficiency were safely managed without increased mortality despite receiving no PLEX or discontinuing PLEX after a short course (upon availability of ADAMTS13 results). In conclusion, ADAMTS13 can be used to diagnose TTP and guide appropriate PLEX therapy.

    View details for DOI 10.1111/bjh.12569

    View details for Web of Science ID 000326034200013

    View details for PubMedID 24111495

  • Warfarin reversal: schism between clinical practice and published guidelines TRANSFUSION Shah, N., Sarode, R. 2013; 53 (3): 476-479

    View details for DOI 10.1111/trf.12104

    View details for Web of Science ID 000315969500002

    View details for PubMedID 23473063

  • Thrombotic thrombocytopenic purpurawhat is new? JOURNAL OF CLINICAL APHERESIS Shah, N., Sarode, R. 2013; 28 (1): 30-35

    Abstract

    A functional deficiency of ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif), a von-Willebrand factor (VWF) cleaving protease, is central to the pathogenesis of congenital and acquired thrombotic thrombocytopenic purpura (TTP). ADAMTS13 testing has evolved from assays that required long denaturation and incubation times to ones that employ a modified recombinant VWF with improved standardization and turn around times. While plasma exchange is a mainstay in the treatment of TTP, increased use of rituximab, an antibody against CD20, has proved helpful in the treatment of patients with exacerbations and relapses. The next generation of drugs focuses on using recombinant ADAMTS13 and molecules that block the interaction of VWF and platelets to prevent thrombotic microangiopathy. The increased awareness and availability of ADAMTS13 testing has also made it possible to detect atypical presentations of TTP such as patients with macrovascular neurological symptoms without accompanying hematological findings as well as help diagnose other causes of thrombotic microangiopathies e.g. atypical hemolytic uremic syndrome. The use of ADAMTS13 testing in the management of TTP should continue to grow especially with newer assays with greater sensitivity, reproducibility, and timelier availability.

    View details for DOI 10.1002/jca.21264

    View details for Web of Science ID 000315218300006

    View details for PubMedID 23420593

Footer Links:

Stanford Medicine Resources: