Hematology   

Is a BM biopsy a must when there is skin involvement? If tryptase level is mildly elevated but less than 20 would you recommend a BM biopsy?

E.g., a patient with newly diagnosed CIDP who is wheelchair-bound.

If so, would you start immediately or wait for the second set of labs to confirm before initiating blood thinners?

Significant history of autoimmune diseases and DVT in family, recent PE/DVT for a month

Nonreliable INR, given hepatic coagulopathy

ANC <500

Also how would you manage this perioperatively?

How is this entity distinct from other secondary HLH entities? 

The patient has no known history of autoimmune disease.

For example, a patient with a bone marrow biopsy that shows normocellular bone marrow. Prior management with leflunomide and HCQ with neutropenia attr...

Are there any instances where you would prefer a biosimilar rather than the reference product? 

Do you wait 12 weeks for confirmation to begin treatment if patient is declining?

Is SLE-related APLS managed differently in terms of anticoagulation?

Although testing was not indicated, what do u do with these results? Other hypercoagulability work up negative

Would the answer differ if the index event was arterial vs venous? 

When it seems fairly certain that this is a drug effect is it something that can just be monitored or requires a change in approach?

If work-up is sent and the patient is found to have a persistently positive antiphospholipid antibody, particularly lupus anticoagulant, would you con...

Currently on nonwarfarin therapeutic anticoagulation

If so, is there one type of antibody that is more likely to cause this false positive test? 

What is the risk of pregnancy loss in absence of anticoagulation? What would you suggest if the patient had anticoagulation in prior pregnancies and r...

Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?

Is it time limited since it may have been triggered by the pregnancy or is it indefinite since it is APLS associated?

I.e., what constitutes well-controlled cancer, IBD, nephrotic syndrome, etc. What other diseases do you put in this category (obesity, autoimmune dise...

(e.g. beta 2 glycoprotein IgM > 20 but <40)

How would the approach differ if the patient had a significant bleeding phenotype vs only minor bruising and mucosal bleeding?

This type of etoposide sparing therapy has been previously described in a case series at https://pubmed.ncbi.nlm.nih.gov/32725881/

If so, how long after diagnosis do you do so? 

Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?

Do you routinely check IgA anticardiolipin and beta-2 glycoprotein antibody IgA in your practice? And how would a positive result change your manageme...

e.g. DITP from eptifibatide after a cardiac intervention

i.e. obstretric APS without thrombosis or SLE

Would chemotherapy be preferred over RT? 

What if the patient is triple-positive or has continued seropositivity on repeat lab testing? What is the appropriate interval of monitoring and does ...

While low-dose aspirin for primary thrombosis prevention in aPL without APS is not typically recommended outside cardiovascular prevention guidelines ...

There are multiple difficulties that could be seen: steroids can precipitate a sickle cell crisis, vasculitis and sickle cell can produce similar clin...

Do you follow the 2019 EULAR Guidelines that SLE patients with asymptomatic, positive aPL should be on low-dose ASA?

What if this was "triple-negative" antiphospholipid syndrome?