patient engagement with the internet. In this study, we assessed the reliability and comprehensiveness of ChatGPT's knowledge and utilized the expertise of hospitalists who meticulously analyzed the responses by AI and contributed to our conclusions. Study: A 20-question survey covering the general blood transfusion-related questions was created on Google document. These questions were entered into ChatGPT in August 2023, and twelve expert hospitalists who consented to the survey evaluated these responses on a Likert scale of Poor, Fair, Good, Very Good, and Excellent. The consensus on the use of Chat GPT as a source of information before blood transfusion was evaluated and shortcomings were discussed. This evaluation aims to shed light on AI's capabilities and limitations in healthcare. The questions were divided into three categories “General Concern Questions”, “Procedure-related questions” and “Technical Questions.” Out of 240 total quality responses, the most common
response was “Very Good” (n=129, 52.8%), followed by “Excellent” (n=65, 27.1%), “Good” (n=36, 15%), “Fair” (n=8,3.3%) and “Poor” (n=2, 0.8%). Discussion: This is the first study that emphasizes the potential of ChatGPT as a high-quality informational resource for patients in the context of blood transfusion. Despite the identification of specific deficiencies, ChatGPT can be employed by patients to educate themselves on the topic of blood transfusion sufficiently. Artificial intelligence (AI) can potentially act as a bridge for the patient and the doctor, making consultations easier and helping the patient comprehend medical concerns and treatments. In conclusion, this study highlights the potential of ChatGPT as a valuable informational resource for patients undergoing blood transfusion, indicative of the growing integration of AI platforms in healthcare, potentially transforming how patients access online information sources.
BREAST ADENOCARCINOMA MASQUERADING AS COLD AGGLUTININ DISEASE: AN UNUSUAL CASE Upasana Agrawal MD, Nitesh Gandhi MD, Shivani Sharma MD; Department of Medicine, LSU Shreveport, Shreveport, LA.
Introduction: Autoimmune hemolytic anemia (AIHA) often accompanies lymphoproliferative malignancies, but it is less common in solid tumors. Cold agglutinin disease (CAD) is an uncommon AIHA subtype. We report a 50-year-old woman whose initial workup was significant for cold agglutinin disease but was later diagnosed with metastatic breast adenocarcinoma. Case: A 50-year-old female with HIV/AIDS presented with facial numbness and blurry vision for the past day. She also reported fatigue, loss of appetite and unintentional weight loss of ten pounds over the past month. Physical examination revealed jaundice. The patient was on antiretroviral treatment for HIV. She had a 16-pack-year smoking history and history of breast cancer in her mother. Hematological workup was significant for cold agglutinin disease (CAD) based on a positive direct Coomb’s test for IgG and high cold agglutinin titers, in addition to low hemoglobin levels, elevated reticulocyte counts, and elevated LDH levels. IgM antibody was positive for Mycoplasma pneumoniae. MRI of the brain showed nonspecific pachymeningeal enhancement. The initial cerebrospinal fluid cytometry after lumbar puncture suggested hematolymphoid malignancy. A
Computed Tomography of the chest, abdomen and pelvis revealed a right breast mass and osteosclerosis. Bone marrow biopsy showed a hypocellular marrow with metastatic carcinoma, favoring mammary origin. Lumbar puncture was repeated, and cytology was positive for metastatic adenocarcinoma. Breast biopsy revealed a low-grade, hormone receptor-positive, invasive lobular carcinoma. The patient received steroids and plasma exchange for treatment of AIHA. She was initiated on Anastrozole, an aromatase inhibitor and Ribociclib, a CD4/CD6 inhibitor for treatment of breast carcinoma. Ribociclib therapy was discontinued due to multiple episodes of anemia and thrombocytopenia requiring transfusions. Her clinical status deteriorated with increasing oxygen requirements and episodes of hypotension. Given her advanced disease and guarded prognosis, the patient and family decided to pursue hospice care. Discussion: Cold agglutinin disease, a type of AIHA, involves circulating IgM antibodies. AIHA can be primary or secondary, with the latter often linked to lymphoproliferative disorders but rarely solid tumors like breast cancer. AIHA can develop before, during, or long after the end 31
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