Benign Hematology&nbsp;&nbsp;&nbsp;

How would you manage a patient with morbid obesity who presents with new symptomatic pulmonary embolism a few days after he was started on DOAC for DVT?

What is your preferred anticoagulation in patients with BMI >50?

How would you work up a patient with cutaneous mastocytosis?

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?

Do you screen adults in your practice with sickle cell disease for silent cerebral infarcts?

The ASH 2020 guidelines have "recommended that adults with HbSS or HbSβ0 thalassemia be screened at least once for silent cerebral infarcts even ...

How do you monitor risk of erythrocytosis from testosterone use for female to male transgender patients?

Is there a role for phlebotomy in secondary polycythemia?

Aside from addressing the underlying case, is there a role for phlebotomy in secondary polycythemia such as in COPD or post-renal transplant erythrocy...

Does PT/PTT elevation due to severe vitamin K deficiency protect against thrombosis?

In the setting of requiring anticoagulation for atrial fibrillation and bioprosthetic valve, but also having severe vitamin K deficiency, would you st...

Are SCDs contraindicated in patients with acute DVTs?

Is it different than early mobility that we always encourage?

For a patient with May-Thurner syndrome and DVT, would you recommend anticoagulation for 3-6 months or indefinitely?

How do you manage hyperalgesia in patients with sickle cell disease?

How do you manage mild Type 1 von Willebrand disease undergoing wisdom teeth removal?

Antifibrinolytic therapy alone +/- DDAVP?

Would you recommend indefinite anticoagulation in any scenario of a provoked clot?

E.g. young male, morbid obesity, with BMI >50

What additional testing is recommended with heterozygous HFE C282Y mutation whose ferritin is elevated and transferrin saturation percentage is at baseline?

Ferritin >2200, TSAT >80%

What is your preferred formulation of parenteral iron?

There are various formulations of intravenous iron; each with varying costs, test dose requirement, elemental dose, and number or time of infusions ne...

Would you extend the duration of anticoagulation in patients with a provoked DVT, but evidence of residual clot at 3 months?

While follow up ultrasound is not usually recommended in provoked DVT, it often is done either for other reasons or by other physicians. Would this in...

How do you approach an ITP patient who responds very well to steroids but the response is short-lived?

How would you counsel the patient if he/she wants to continue on steroids?

Do you use FVIII levels to differentiate between DIC and coagulopathy of liver disease?

Common thought is that FVIII may be used for differentiating coagulopathy in liver disease (normal to increased, from reduced clearance of VWF/FVIII) ...

Does phosphatidylserine antibody play a role in the diagnosis of antiphospholipid antibody syndrome?

How do you manage occlusive bilateral retinal vasculitis with isolated lupus anticoagulant positivity?

How do you approach anticoagulation in the setting of HIT and thrombocytopenia?

I.e. platelet count <30. Would your management change if HIT were only suspected rather than confirmed?

In what situations would you consider ESAs in hospitalized patients with severe anemia for indications other than CKD or myelosuppressive chemotherapy (e.g., ACD, hemorrhage)?

Practice is variable in the community, with some hematologists frequently prescribing ESAs for severe anemia that is mostly inflammatory. Do the risks...

Is there a role for rituximab in refractory HIT?

How would you treat a woman with iron deficiency anemia, unresponsive to iron sulfate, and with allergic reaction to iron sucrose?

Anemia is secondary to menorrhagia. No gynecologic interventions were possible.

Are there any possible scenarios where you would do phlebotomies for heterozygous hemochromatosis?

How long do you anticoagulate for cirrhosis patients who have portal vein thrombosis extending to the mesenteric veins?

How long post operatively do you wait before transitioning from parenteral anticoagulation to oral anticoagulants after pulmonary thromboendarterectomy for CTEPH?

How do you dose apixaban in patients with CrCl <30 mL/minute?

For an asymptomatic patient discovered during workup for elevated PT/PTT to have mild prothrombin deficiency, would you suggest any preoperative prophylaxis?

Level >60%. No family or surgical h/o of bleeding but heavy postpartum bleeding.

Would you treat a hemochromatosis carrier with IV iron if they have iron deficiency anemia in conjunction with elevated ferritin?

Hb <11, low iron saturation (<10%), high ferritin (>900), and low reticulocyte hemoglobin equivalent.

In a patient with a history of HIT, how would you reintroduce Heparin?

Is it only done when heparin is used in an emergency?

Do you consider starting hydroxyurea in a patient with hemoglobin S-beta thalassemia with chronic kidney disease secondary to FSGS?

No transfusion dependence but has hemoglobin in the 8-9 g/dl range.

How do you manage drug-drug interactions between oral anticoagulants and the ARSI agents such as apalutamide and enzalutamide?

In extremely obese patients with spontaneous DVT/PE who have been anticoagulated for > 6 months, do you feel comfortable reducing the DOAC to prophylactic dose or do you prefer continuing full dose indefinite anticoagulation?

BMI>40

What is your approach to using medications that can cause bone marrow suppression in SLE patients who have persistent leukopenia?

Would you anticoagulate a patient with splenic infarctions in the setting of CMV viremia?

If so, for how long?

What are the indications for anticoagulation in splenic infarctions?

What is the work up and what is the duration of anticoagulation if used?

How do you interpret a low VWF activity/antigen ratio, when both activity and antigen levels are above 50%?

E.g. Normal F8, VWF activity ~50%, VWF antigen ~100%, ratio 0.5 sent in a patient with positive bleeding history Is there any clinical significance t...

What is the ideal period to wait until curative surgery for patients with acute pulmonary embolism and solid malignancy?

Specifically, asymptomatic subsegmental PE diagnosed within a month from planned bilateral mastectomy for breast cancer.

How do you manage a DOAC if interested in testing for lupus anticoagulant?

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

How would you approach a woman with APLA but no thrombosis/APLS, a history of ITP without bleeding who is now pregnant?

How do you manage me anticoagulation in a patient with May Thurner Syndrome, who does not have history of thrombosis, and becomes pregnant?

Can you use apixaban or rivaroxaban in case of dabigatran failure?

When should you use caplacizumab in the treatment of acute TTP patients?

Would you give transdermal hormone replacement therapy to a woman with remote history of provoked pulmonary embolism?

Is patch or gel HRT with ASA prophylaxis a reasonable option after counseling? Or do you add a prophylactic DOAC?

Is there a correlation between spleen size and degree of thrombocytopenia?

What would your next line of treatment be for a patient with Hb SC with history of recurrent VOC and new bone infarct who is already on hydroxyurea and phlebotomy?

Hb at goal of 9-10

How would you manage warfarin in a patient with APLS and alcoholic cirrhosis?

Nonreliable INR, given hepatic coagulopathy

How do you treat a patient with warfarin failure, with therapeutic INR 2-3 at the time of DVT, and no underlying malignancy or hypercoagulable state?

Is lifelong LMWH the anticoagulant of choice? Would DOACs be an option?

Is it true that a ferritin above 200 essentially rules out iron deficiency?

Does this hold true when the patient has significant inflammation?

How is transferrin saturation a reliable indicator for any parameter if serum iron is not reliable?

Although TIBC is negative acute phase reactant, would it be a better indicator of iron deficiency (in combination with ferritin)?

Should testing for genetic causes of HLH be performed in all patients with MAS or secondary HLH regardless of the patient's age?

What is your practice for work up and treatment of incidental splenic infarcts with or without splenomegaly in patients without sickle cell disease?

Is bone marrow biopsy indicated in patients with primary polycythemia but negative for JAK2 mutation including exon 12?

In antiphospholipid syndrome with recurrent strokes, would you consider adding antiplatelets to warfarin?

Also how would you manage this perioperatively?

7 Answers available

Would you recommend use of ESA for anemia of kidney disease in the setting of metastatic solid tumor malignancy?

How do you approach very treatment-refractory ITP?

Such as the case in which a patient is unresponsive to steroids, IVIG, TPO-agonist, rituximab, splenectomy, and even fostamitinib.

How would you work up an elevated copper level without cytopenias in a patient with history of bariatric surgery not on supplements or using copper utensils?

Often see bariatric surgery ordering these tests, is there any clinical relevance?

For patients with incidental findings of venous thromboembolism during workup of a treatable malignancy, how do you approach discontinuation after the treatment is complete?

Would you consider low dose indefinite anticoagulation in any scenario? Any difference in approach between hematological malignancy and solid tum...

In a young female with severe osteoporosis due to congenital estrogen deficiency, can estrogen be prescribed if genetic testing for congenital disorders reveals a heterozygous Factor V Leiden mutation?

No prior thrombosis; no family history of thrombosis. As per endocrine, the only useful therapy for the osteoporosis is estrogen.

Would you start anticoagulation in a patient with a history of CVA 1 year ago and high risk APL profile who was never started on anticoagulation, but is now presenting for follow up and without recurrent thrombotic events?

The patient has no known history of autoimmune disease.

In the setting of secondary HLH associated with initial diagnosis of lymphoma, would you adjust steroid dose and type to account for differences in HLH and lymphoma treatment protocols?

When should I consider anticoagulation in an unprovoked upper extremity superficial venous thrombosis?

Would it change your management if the thrombus was symptomatic? Or if larger >3 cm?

What are your options for refractory ITP after steroids and TPO for elderly patients?

Would you escalate treatment for a clinically stable/asymptomatic lupus patient with persistent leukopenia/neutropenia, already on hydroxychloroquine?

6 Answers available

What is your approach to further work-up and management of neutropenia in patients with SLE/RA overlap?

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

What additional testing besides LAC/APLS, factor V Leiden, prothrombin gene mutation, JAK 2 do you draw for unprovoked cerebral venous sinus thrombosis?

What is the best approach to manage iron overload secondary to both heterozygous HFE gene mutation and two heterozygous aceruloplasminemia gene mutations?

Any particular labs or imaging indicated?

What are your recommendations for adult sickle cell patients who end up being admitted several times a year for pain crises despite hydroxyurea, crizanlizumab, voxelotor, etc?

What can you recommend that might help keep them out of the hospital? Do you consider a program of exchange transfusions in this situation?

How do you manage anticoagulation bridging for outpatient ESKD patients given concerns for bleeding risk with enoxaparin in this population?

Would you bridge with enoxaparin 0.7 mg/kg/day in an ESKD patient, as described in a previous retrospective study (Pon et al., PMID: 24718051)?

In a patient hospitalized for several days with a refractory pain crisis would you ever consider transfusion, either simple or possibly exchange in an attempt to get the patient over the crisis?

Do you recommend hydroxyurea in patients with sickle cell disease with hereditary persistence of fetal hemoglobin who have recurrent vaso-occlusive crises requiring hospital admission?

If hydroxyurea modifies the course of sickle cell disease by increasing fetal hemoglobin, is there any benefit to using it in patients with fetal hemo...

When do you refer AYA patients with newly diagnosed severe aplastic anemia for transplant?

Would you give a trial of IST first or immediately refer for SCT if the patient has matched siblings?

Would you use PCC for clotting factor repletion in acute life threatening hemorrhage in a patient with elevated INR from coagulopathy of liver disease?

When should I consider anticoagulation in an unprovoked upper extremity deep venous thrombosis?

For example: In a patient presenting with left arm swelling and found to have a left cephalic vein occlusive thrombus on ultrasound

Should all patients diagnosed with B12 deficiency get a baseline EGD?

Should they be placed on routine EGD surveillance and if yes at what intervals?

How do you approach a patient with chronic low ADAMTS13 activity and low level of inhibitor without signs of thrombocytopenia or hemolysis?

ADAMTS13 level <5% Inhibitor level <1

How do you explain TTP to patients?

In a patient with APS and obesity during pregnancy when switched to LMWH, do you cap the dose of dalteparin as per manufacturers labeling at 18,000U per day or do you use weight based dosing?

Would you anticoagulate a patient with an asymptomatic gonadal vein thrombosis on CT scan, found on surveillance imaging for colorectal cancer?

Is there a role for hydroxychloroquine for secondary prevention in patients with APS without SLE?

Do you repeat images in patients with venous thrombosis to inform decision about duration of anticoagulation?

E.g. pulmonary embolism, portal vein thrombosis, cerebral venous sinus thrombosis

Do you recommend starting an antiplatelet for primary prophylaxis in post splenectomy thrombocytosis given there is some increased risk of venous thrombosis?

If so, what platelet count threshold would you use? Would age impact your decision? Would you do a bone marrow to rule out primary MPD in adults if th...

Would you continue warfarin anticoagulation in patients with unprovoked DVT if switching to low-dose DOAC is cost-prohibitive?

How do you manage a patient with JAK2+ ET without history of thrombosis during pregnancy?

Does history of miscarriage affect your treatment decision?

Would you consider antiphospholipid syndrome to be a contraindication for checkpoint inhibitor immunotherapy?

How do you differentiate between JAK2 positive ET and PV when peripheral blood shows erythrocytosis and thrombocytosis?

Concordant low EPO level and bone marrow with megakaryocyte hyperplasia

How do you perform fertility counseling for a patient with a duplication of one of the alpha genes and their partner who has a beta chain point mutation?

That is, extra copy of one of the alpha genes resulting in an atypical alpha thalassemia for the patient, and beta thalassemia heterozygous carrier fo...

What precautions do you take prior to CABG in a patient with sickle cell trait?

Please comment on temperature recommendations and role of exchange transfusion.

Do you use anticoagulation in cancer patients who develop an unprovoked superficial vein thrombosis?

If so, do you treat for a limited period of time or indefinitely?

In sickle cell patients with continued pain crises despite hydroxyurea, how do we sequence the use of newer agents?

While L-glutamine has minimal side effects and would likely be added after hydrea, how do you decide between the use of voxelotor and crizanlizumab?

How do you approach low to moderate titer of APLS when working up unprovoked DVT if it is persistent on repeat testing?

Would you consider using DOACs in a young patient with SLE and Libman-Sacks endocarditis, who is negative for APS?

Do you screen for VWD in all women with menorrhagia severe enough to cause iron deficiency anemia?

How would you manage anti-platelet therapy in patients presenting with ischemic stroke and have a history of von Willebrand disease?

How should elevated PT of unclear etiology and significance be evaluated?

In the absence of concerning bleeding or thrombosis, family history of coagulopathy, current anticoagulant use, or malnutrition

How would you counsel a patient with active SLE on treatment, low to moderate level of one of the APLS antibodies, and remote history of provoked blood clot regarding perioperative anticoagulation?

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

How would you manage a patient with erythrocytosis of unknown cause in pregnancy?

MPN work-up negative

How do you manage a patient with a nonspecific platelet function disorder and heterozygous protein C deficiency during pregnancy?

Specifically - patient who had mild aggregation defect with ADP which corrected in third trimester of pregnancy. Would it be appropriate or necessary ...

How would you approach a low to moderate titer of one of the APLS antibodies in a patient with a strong family history but no personal history of thrombosis?

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

Do you send an antiphospholipid antibody panel routinely for all patients with an unprovoked thrombus?

Would you restart prophylactic anticoagulation in a patient with a history of unprovoked PE who received short term anticoagulation with a prior physician?

E.g. low dose DOAC

Is rituximab for refractory ITP contraindicated in the setting of an active COVID infection, particularly in a patient with asymptomatic COVID?

Would you discontinue anticoagulation in patients with antiphospholipid antibody syndrome, who have a remote history of thrombotic events and are now negative for pathogenic antiphospholipid antibodies?

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

Is there any role in continuing apixaban in a patient with occlusion of the right internal jugular vein with chronic postthrombotic change to prevent a recurrent DVT?

Previous provoking factors resolved (CVC, malignancy, etc)

How do you advise patients with sickle cell disease on contraception?

Do you advise against combination OCPs?

Would you consider thrombophilia testing in a pregnant patient with VTE?

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

What is your perioperative approach for a patient with severe hemophilia?

What type, dosage, and duration of treatment do you use? How does your practice change when there is an inhibitor?

For a patient with PE undergoing procedures like port placement in the first month, how do you manage anticoagulation?

What is your preferred agent (DOAC, warfarin, enoxaparin), and is periprocedural bridging necessary?

How do you manage prophylactic antimicrobial medications in patients who undergo ATG/cyclosporine/eltrombopag induction for severe aplastic anemia?

What would you recommend within the first year after ATG and thereafter if still maintained on cyclosporine?

How do you work up a young patient with increasing ferritin and normal TSAT without infectious, inflammatory, or liver disorders?

Ferritin uptrending >1000, no additional lab abnormalities. HFE wildtype. Too young for age-appropriate cancer screening. Asymptomatic except fatig...

What is the optimal management of a patient needing surgical clearance for a knee replacement with VWF Ag and factor VIII between 40-50 and no bleeding history?

In a patient with Type I von Willebrand disease with history of VTE and heavy menses, would tranexamic acid be a treatment option?

Is thrombotic risk too significant? Patient failed OCPs.

Do you stop hydroxyurea or switch to an alternative therapy in a male patient with controlled Hb SC disease who is interested in having children?

When can abdominal surgery be safely performed for presumptive ovarian cancer in a patient with recent pulmonary emboli?

(Normal oxygenation and echo)

Is there a role for low dose aspirin in a patient with AVN in four large joints who has underlying well-controlled SLE and positive APLs but no history of clots?

Can APLS cause a false positive HIT ELISA?

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

At what ferritin threshold would a patient with anemia of inflammation or malignancy no longer benefit from iron supplementation for functional iron deficiency?

For example, if TSAT is less than 20% but ferritin is over 200.

How do you workup splenomegaly related to possible hematologic etiology in the absence of abnormal blood counts, adenopathy or severe constitutional symptoms?

For instance, evaluation by primary care and GI without other etiology for splenomegaly

Do you recommend continuous antibiotic prophylaxis for patients on complement inhibitors such as eculizumab?

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

Do you treat secondary erythrocytosis caused by SGLT2 inhibitor?

Based on recent data would you consider adding ATRA to low dose rituximab for steroid refractory ITP?

Wu et al., PMID 34665865

Other than B12 repletion, is there any further treatment or work-up indicated in pernicious anemia with positive parietal cell antibodies?

When considering the use of DOACs in APLS, does the number of positive APLS antibodies influence your decision?

When do you stop trying to eradicate an acquired factor VIII inhibitor?

Patient with high titer acquired FVIII inhibitor with no causative etiology. Bleeding is well-controlled on emicizumab, but inhibitor has failed...

Would you give IV iron for low TSAT in patients with MDS anemia who are transfusion independent but on an ESA?

i.e. similar to CKD anemia?

How long would you consider the use of low-dose aspirin in a patient with SLE and high risk aPL profile (without a clinical event)?

Do you recommend long term anticoagulation for all patients with first time unprovoked VTE?

What recommendations do you have for a transgender female patient with history of prothrombin gene mutation who is interested in starting gender affirming hormone therapy?

The patient has no personal history of VTE, but has positive family history of VTE. Any prophylactic anticoagulation options? How would manage...

Do you hold IV iron in the setting of active infection?

Do you routinely send NGS testing from bone marrow samples in patients with unexplained cytopenia or cytoses?

For instance, if clonal hematopoiesis of indeterminate potential (CHIP) suspected

In patients with severe hemophilia A on emicizumab for prophylaxis, in case of noncompliance leading to a lapse of more than 2-3 months off therapy, do you reload with emicizumab?

In a patient identified as having APLS because of recurrent pregnancy loss without history of thrombosis, but now has a new DVT/PE during pregnancy despite use of enoxaparin—for how long would you recommend anticoagulation?

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

What is the preferred immunosuppressive modality for patients with an acquired factor 8 inhibitor?

In patients who develop a VTE, what conditions do you consider as persistent, provoking risk factors, and at what point are they controlled enough to stop anticoagulation?

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

How soon do you anticipate response to cyclosporine in red cell aplasia and what cyclosporine trough levels do you target?

How would you work up and manage persistent lymphopenia in an asymptomatic patient?

ALC<200

Do you consider travel as a risk factor for DVTs in the absence of any other underlying predisposing factors?

i.e. long car rides or plane rides

How would you manage an incidental catheter-related thrombosis in a functioning dialysis catheter?

- Dialysis catheter used for hemodialysis- RIJ thrombus in dialysis catheter was incidentally found- Patient asymptomatic with no prior history of VTE...

Do you offer iron supplementation to a non-anemic adolescent athlete with a low ferritin?

Is an elevated CRP an expected finding in an otherwise healthy patient with hemoglobin S - alpha thalassemia?

CRP 39 mg/L (normal < 10) and normal ESR

How would you manage someone with antithrombin deficiency who has recurrent VTE on a DOAC?

APLA syndrome, obesity, non compliance ruled out and prefers another oral anticoagulation. Is higher dose of rivaroxaban or apixaban an option?

Does normal methylmalonic acid levels absolutely rule out vitamin B12 deficiency?

In a patient with a bleeding disorder, how would one approach anticoagulation during active COVID infection?

Bleeding disorder such as vWD

In a patient with sickle cell disease on hydroxyurea who is planning to have a family, for how long should they be off the drug before trying to conceive?

At what platelet count would you feel comfortable dosing aspirin 81 mg for coronary artery disease in a patient with ITP?

Presuming strong indication for ASA - eg history of NSTEMI

How do you counsel patients with elevated factor VIII levels for their thrombosis risk?

Should we stop checking factor VIII levels as part of thrombosis workup?

How would you approach protein S deficiency found on hypercoagulability work-up in a patient with a post-operative central retinal vein occlusion?

In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...

How do you interpret elevations in antiphospholipid antibodies that are lower than Sapporo criteria?

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

Would you give antithrombin concentrate for surgical VTE prophylaxis in case of congenital AT deficiency?

To what extent does the degree of thrombocytopenia correlate with the severity of cirrhosis?

How do you manage patients who develop minor antigen antibodies and require multiple blood transfusions?

e.g. K, Fya, s, etc

How do you manage a patient with sickle cell disease during pregnancy?

How long after starting anticoagulation would you remove an IVC filter in a patient with a DVT presenting with stroke and PFO which is now closed?

How do you determine duration of anticoagulation for an ovarian vein thrombosis following a provoking event?

Would you anticoagulate recurrent venous thromboembolism in a patient with Ehlers Danlos syndrome?

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

What are your recommendations for management of patients with familial polycythemia due to EPOR mutation during pregnancy?

Would you retry rituximab in steroid refractory warm autoimmune hemolytic anemia which responded to rituximab before?

Last rituximab 6 months ago

What are the alternatives to anticoagulation in an individual with an atrial thrombus and absolute contraindications to anticoagulation?

How would you manage a patient with essential thrombocythemia and persistent pruritus despite adequate control of CBC with hydroxyurea and aspirin?

ET is JAK2+

When and how do you initiate therapeutic phlebotomy for patients with hereditary hemochromatosis without evidence of end-organ injury?

Would you give a TPO agonist for thrombocytopenia in alcoholic cirrhosis?

Would you check vitamin B6 routinely in the work up of anemia?

How do you approach heparin management in patients who have suprathetherapeutic Xa levels on minimal heparin?

Do you repeat antiphospholipid antibody testing in a patient that previously met criteria for APLS?

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

What is your recommended management algorithm for bleeding associated with an acquired factor VIII inhibitor?

When do you consider plasma exchange for multiorgan failure in a patient with sickle cell disease?

How do you manage recurrent portal vein thromboses in a patient with JAK2+ PV on therapeutic anticoagulation and appropriate cytoreduction?

Recurrent thromboses despite therapeutic enoxaparin. Other hypercoagulable work-up negative.

Does 4G/5G polymorphism in the plasminogen activator inhibitor (PAI-1) gene increase the risk of thrombosis?

In the absence of a VTE would you consider prophylaxis after a surgical procedure? Often non-hematologists order this testing but we are consulted for...

Does potential longterm risk for leukemia influence your decision for using hydroxyurea in young patients with myeloproliferative neoplasms?

Would pegylated interferon be preferred?

Are there any situations you would recommend prophylactic anticoagulation for a patient with Factor V heterozygosity?

FVL heterozygotes are often treated similarly to the general population. Aside from avoiding other VTE risk factors, are there situations where prophy...

In which platelet function disorders would you consider use of Novoseven as opposed to platelet transfusion?

Are there particular clinical scenarios that would affect your decision?

How have you been counseling patients with sickle cell regarding a 3rd COVID vaccine?

Would you consider using HMA in management of polycythemia vera?

i.e. treatment-refractory PV, prior to progression to PMF or AML

Should we recommend the COVID-19 booster vaccine to patients who had a DVT or any other complications such as hemolytic anemia or thrombocytopenia from prior vaccine doses?

Do you find IgA isotypes of anti-beta2-glycoprotein antibodies and anticardiolipin antibodies to be clinically useful in the evaluation for APS?

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

In a patient with a heterozygous prothrombin gene mutation who has COVID with minimal symptoms, do you recommend prophylactic and/or therapeutic anticoagulation?

Is antiplatelet or anticoagulant therapy preferred for the secondary prophylaxis of cryptogenic stroke in a patient with underlying malignancy?

How do you manage drug-induced thrombocytopenia when the implicated drug is essential?

e.g. DITP from eptifibatide after a cardiac intervention

What is your preferred anticoagulant for acute portal vein thrombosis?

How does cirrhosis and/or underlying thrombophilia affect your decision?

For treatment of ITP, what would you add to dexamethasone to achieve the fastest recovery in a patient waiting for a procedure?

IVIG, TPO, or other agents?

What are your considerations for peri-operative anticoagulation in patients with a mechanical heart valve undergoing a major noncardiac surgery?

Please comment on bridging.

What are contraindications for growth factors in patients with hematologic malignancies?

Do you routinely check platelet counts after COVID-19 vaccines in patients with chronic ITP?

Does variable allele frequency (VAF) of JAK mutation affect your clinical decision-making in MPN in any scenario?

Does VAF <1% make you want to do a BM biopsy for confirmation?

Does testing for elevated serum homocysteine have any relevance in thrombophilia management?

What should be done with a high level?

How do you counsel male-to-female transgender patients on the VTE risk of hormonal therapy?

Are you comfortable using DOACs in obese patients with VTE?

How would you manage a patient with JAK2-positive PV who is not responding to hydroxyurea or IFN-alpha for cytoreduction?

This is in the setting of a patient who is now on ruxolitinib with rising leukocytosis and thrombocytosis, but cannot be on aspirin due to recent blee...

What is your experience managing myelosuppression from busulfan, prescribed for PV?

Do you approach the diagnosis and treatment of HIT patients differently in the outpatient setting or in a resource-limited community setting?

For example, for outpatients or resource-limited settings with a moderate probability 4-T score (but low clinical suspicion), would you ever consider ...

How do you manage HIT in a patient with high bleeding risk?

e.g. in the setting of using prophylactic heparin in the past but now requiring therapeutic anticoagulation

What is your typical workup for a patient with a spontaneous renal infarct?

Please also discuss the type and duration of anticoagulation.

How do you manage a patient with transfusion-dependent MDS with concurrent hemochromatosis requiring phlebotomy?

In patients with thrombocytosis with negative MPN workup from peripheral blood and bone marrow, is there a role for daily 81mg aspirin or other treatment?

Is there experience/reports of using voxelotor in sickle cell patients who are Jehovah Witnesses with few crises but who have fatigue and/or dyspnea?

Also is there value in using voxelotor for the purpose of reducing hemolysis, and if so what parameters do you use to determine when to initiate voxel...

Do you routinely check for copper deficiency as part of workup for bicytopenia with leukopenia/anemia or pancytopenia?

What is your preferred approach for patients with anti-phospholipid syndrome with recurrent thrombosis on coumadin and LMWH?

How would you approach moderate neutropenia (ANC < 1000) in a solid organ transplant recipient?

Is there a particular sequence you would adjust contributing antirejection or antimicrobial medications? Is the use of G-CSF appropriate and at what c...

Are there any circumstances where you consider repeating CT Angiogram Chest after 3-6 months of anticoagulation for pulmonary embolism?

Is prophylactic anticoagulation indicated in patients with frequent ulcerative colitis flares?

If so, what agent(s) do you prefer?

What is the role of hydroxyurea in variant sickle cell genotypes?

Hydroxyurea is demonstrated to reduce complications and improve long-term outcomes in severe genotypes HbSS and sickle beta0 thalassemia. What clinica...

How do you diagnose sickle hepatopathy?

What is your standard workup and treatment for an incidentally-noted splanchnic vein thrombosis?

What is your duration of anticoagulation?

In what circumstances would you give G-CSF to a patient with severe neutropenia and HLH?

What is your approach to a patient with positive antiphospholipid antibodies who otherwise do not meet clinical criteria for APS?

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

Do you utilize D-dimer to inform anticoagulation duration in the treatment of VTE?

Provoked or unprovoked VTE: Do you use D-Dimer (or even repeat imaging to reassess residual clot) in any capacity to guide anticoagulation duration? E...

How would you manage VTE in a patient with bleeding disorder such as hemophilia?

Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?

In your practice, do you usually check MMA and B12 simultaneously or start with B12 levels and check MMA only if indeterminate?

Do you recommend COVID vaccination in patients with antiphospholipid antibody positivity or other prothrombotic states not on anti-coagulation?

How would you manage a patient with acquired von Willebrand disease who requires DAPT for arterial disease?

In the absence of symptoms would you still treat high risk myelofibrosis if transplant ineligible?

Is leukocytosis and thrombocytosis alone an indication for treatment?

Would you treat iron deficiency in post PV myelofibrosis if anemia is the predominant concern?

In a patient with progressive thrombocytosis but negative MPN mutations on peripheral blood, what are your diagnostic and treatment recommendations?

Do you ever recheck JAK2/CALR/MPL/BCR-ABL? Would you recommend a bone marrow biopsy? Is cytoreductive therapy indicated?

When do you check for EPOR gene mutations in your workup for erythrocytosis, and if found, how do you manage it?

Is there a role for aspirin or hydroxyurea? Do you perform phlebotomy, and if so, what goals?

What hematologic conditions are contraindications for a COVID vaccine?

How would you manage a patient with type 1 cryoglobulinemia secondary to MGUS?

What if the patient is no longer responding to steroids?

Do you consider low-dose aspirin for primary thromboprophylaxis in patients with high-risk antiphospholipid antibody profiles?

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

How do you approach management of sickle cell patients who mistrust Western medicine and prefer naturopathic therapies?

While building a trusting patient-physician relationship, what therapies could be discussed that may be aligned with naturopathic medicine? (i.e. L-gl...

What is the anticoagulation recommendation for a chronic DVT?

Would you routinely use G-CSF prophylaxis in a CMML patient for decitabine-related neutropenia?

In the rare setting of enoxaparin injection-induced abdominal wall hematoma in patients requiring long-term anticoagulation, what is your timeline for restarting anticoagulation?

Would appreciate expert opinion on when to reimage and when to restart anticoagulation depending on findings.

In which patients with oncologic or hematologic disorders are you recommending a 3rd dose of mRNA COVID vaccine?

What is the role, if any, for next generation sequencing testing in patients with suspected MPN who test negative for commonly identified mutations such as JAK2, CALR, MPL, and BCR-ABL?

How would you manage symptomatic iron deficiency in patients with PV on frequent phlebotomies?

Is this a reason to start hydrea? Would you give oral iron after adequate control on hydrea?

Do you recommend anticoagulation for a splenic infarct in patients with myelofibrosis and splenomegaly?

What is the maximum pRBC volume you can transfuse when performing a manual exchange transfusion in an adult-sized patient with sickle cell disease?

How often should you repeat iron testing in patients with hemochromatosis, not on phlebotomy?

Patient with ferritin level <1000 ng/mL and no evidence of end-organ damage

How soon after a VTE would you feel comfortable with a patient undergoing an elective surgery?

While there are many factors involving:- type (DVT vs PE, unprovoked vs provoked) and severity of venous thromboembolism (VTE) size- duration of antic...

How do you approach an isolated T-cell gene arrangement found in the setting of persistent hypereosinophilia?

If all work-up including peripheral flow, bone marrow biopsy, PET-CT returns negative, what additional management (if any) would be recommended?

Do you use premedications (acetaminophen, diphenhydramine) before pRBC and plt transfusions to prevent febrile nonhemolytic transfusion reactions and allergic reactions?

Does manipulation of blood products (leukoreduction, irradiated) affect your approach? There is growing evidence that routine premedication (at least ...

Under what circumstances would you consider anticoagulation in a young female patient with persistently elevated factor XI activity?

While this is a known risk factor for venous [Meijers et al NEJM 2000] and potentially arterial [Yang et al, Am J Clin Pathol 2006] thrombosis, it is ...

Would you offer a complement inhibitor to a minimally symptomatic PNH patient with mild non-transfusion dependent hemolytic anemia?

What is your perioperative approach to holding and restarting hydroxyurea in patients with essential thrombocythemia?

Are there any special considerations when evaluating patients with non-malignant hematologic or immunodeficiency disorders for allogeneic transplant?

Are there major differences in standard conditioning and/or GVHD prophylaxis regimens utilized? Does the non-relapse mortality different significantl...

With what agents can you replace PPIs if they cause thrombocytopenia?

Should platelet transfusions be considered for anti-platelet agent reversal in patients with major bleeding?

Should assessing for a MTHFR mutation be part of the thrombophilia evaluation in a patient presenting with a thrombus?

How long do you continue caplacizumab in relapsed refractory TTP?

How often do you monitor ADAMTS-13 levels off therapy?

Are there any reasons to consider a prolonged course of steroids with taper over a shorter course of pulsed steroids in the treatment of ITP?

For example, do we prefer one regimen over the other in patients with a bleeding history or who have relapsed after a lengthy remission?

Can you use other iron formulations if a patient develops Stevens-Johnson Syndrome with ferumoxytol?

How often do you follow ferritin and organ iron-deposition in a patient who has known hereditary hemochromatosis, but no current evidence of iron overload?

e.g. a genetic mutation picked up through a family member

Is there any role for iron chelation in a patient with iatrogenic transfusion-induced iron overload such as in patients with end-stage kidney or liver disease?

Does transplant eligibility make a difference for management?

How do you manage testosterone replacement therapy-induced erythrocytosis?

Do you recommend therapeutic phlebotomy to a certain Hct goal? Any strong evidence for thromboembolic risk related to erythrocytosis or if this is mit...

Do you routinely obtain bone marrow biopsy in newly diagnosed autoimmune hemolytic anemia when working up potential underlying etiologies?

How do you advise a patient with VTE on indefinite anticoagulants regarding the Ad26.COV2.S Johnson & Johnson/Janssen COVID vaccine?

How do you approach evaluation of pulmonary vein thrombosis?

Is there any difference between anticoagulants in this clinical context (e.g. anti-Xa inhibitors vs warfarin vs LMWH)?

How would you approach chronic isolated severe non-cyclic neutropenia with negative bone marrow and rheumatologic work-up?

Is there a role for empiric antibiotics if there is history of opportunistic infection?

How do you approach the treatment of drug-induced thrombotic microangiopathy?

When do you consider initiating eculizumab?

Do you consider splenic response as adequate to judge efficacy of JAK2 inhibitors in myeloproliferative disorders?

What is the transfusion management of a sickle cell patient during pregnancy?

What are your target goals during transfusion, either prophylactically or during acute complication? Does your management change between vaginal deliv...

How would you advise patients with known stable autoimmune thrombocytopenia regarding the Ad26.COV2.S (Johnson & Johnson/Janssen) vaccine?

In patients with autoimmune cytopenias, is there any reservation for COVID vaccination?

While benefits outweigh known harms and limited data, do you worry about vaccination in patients with a history of or active autoimmune cytopenias (e....

How do you approach transfusing a patient with sickle cell disease who has a history of hyperhemolysis?

0 Answers available

When (if ever) do you check for anti-platelet antibodies for workup of thrombocytopenia?

In patients with a history of HIT, how do you counsel them on the use of the AstraZeneca vaccine given reports of unusual thrombosis and association with PF4/heparin antibodies?

AstraZeneca may cause PF4 antibodies leading to vaccine-induced prothrombotic immune thrombocytopenia (VIPIT).

Do you check pertussis serologies when sending labs for antiphospholipid syndrome?

In a patient with breakthrough VTE on rivaroxaban, would you switch to apixaban or an agent with a different mechanism of action?

Assuming the patient is a candidate for all anticoagulation options (no mechanical valve, antiphospholipid syndrome, patient-specific contraindication...

Should patients receive thrombophilia testing in the setting of a provoked VTE secondary to hormonal therapy/OCPs?

While thrombophilia testing is not routinely recommended prior to starting OCPs, how about after the development of a VTE?

How would you manage a patient with antiphospholipid syndrome in the setting of severe steroid-refractory thrombocytopenia?

Especially in a triple-positive patient with an acute ischemic stroke who may have urgency for anticoagulation with high bleeding risk and severe thro...

Would you ever consider prophylactic anticoagulation in patients with CKD requiring ESA therapy?

While the CKD population is at high thrombotic and bleeding risk, would you consider anticoagulating a patient prophylactically if they had a history ...

How do you treat refractory cold agglutinin disease?

The patient who has not responded to steroids, rituximab/bendamustine, and splenectomy?

What is the best way to monitor intraoperative heparin use in a patient with factor XII deficiency?

In a patient with severe factor XII deficiency with a baseline prolonged PTT, what is the best method to monitor their ACT or heparin levels when on c...

Do you routinely start anticoagulation for a patient with newly diagnosed hepatocellular carcinoma presenting with a portal venous thrombosis?

How do you approach the treatment of ITP in a pregnant patient who did not respond to prednisone?

Would you consider high-dose dexamethasone (deliberating adverse effects of antenatal steroids) or move to next-line therapies?

How can healthcare providers better serve as allies of the sickle cell community?

Has your medical practice taken any steps either in community outreach or within the clinic to show support for this medically vulnerable population, ...

What could explain discordant iron studies?

For a patient with low ferritin, but high TSAT?

How do you workup erythrocytosis with a normal or elevated serum erythropoietin?

Do you generally reduce DOAC dosing for extended anticoagulation in patients with first unprovoked VTE?

Ref: EINSTEIN-CHOICE and AMPLIFY-EXT Would you approach this differently in patients with inherited thrombophilias?

What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?

Do you account for the effect of coffee on platelet aggregation studies?

Why are autoantibodies not often detected on monoclonal gammopathy assays (SPEP/IFE, quantitiative immunoglobulins)?

For example, in cold agglutinin disease or AIHA, antibodies can be detected via DAT, but are often not observed on assays for monoclonal gammopathies.

How would you approach the treatment of patients with von Willebrand disease or hemophilia A previously managed with intranasal DDAVP during the recall?

During the Stimate recall, how are we performing DDAVP challenges for newly diagnosed hemophilia A or von Willebrand disease?

Is there an equivalent test for serum viscosity in sickle cell disease?

Is there a role for G-CSF treatment for SLE patients with persistent neutropenia?

Do you routinely refer young patients with iron deficiency anemia for GI evaluation?

In low-risk patients (age < 40) or patients with very obvious causes of blood loss or iron deficiency (menorrhagia, pregnancy), do you routinely pe...

How do you approach unresectable or borderline resectable symptomatic nasal/paranasal Rosai-Dorfman disease?

Are there effective therapy options that do not include steroids?

In which patients with atypical HUS would you consider eculizumab discontinuation?

Given the high cost of eculizumab, are there patient characteristics that inform which patients, if any, should be on indefinite therapy versus a time...

How do you manage a delayed hemolytic transfusion reaction in a patient with sickle cell disease?

How do you manage an uncomplicated DHTFR versus a hyperhemolysis?

What is your threshold for pursuing bone marrow biopsy in a lupus patient with cytopenias?

How do you approach the management of a patient with symptomatic iron deficiency anemia who is intolerant of iron?

Such as a patient who cannot tolerate oral iron and has had a anaphylaxis to intravenous iron

What is the target ferritin level for patients with hereditary hemochromatosis and signs of end-organ damage?

For example, a patient with hypogonadism unless it matters which organ is involved. Are other markers of iron storage useful in guiding therapy?

How do you approach anticoagulation in patients with catastrophic antiphospholipid syndrome and thrombocytopenia?

What are your thoughts on adding mycophenolate to steroids in the first line treatment of ITP based on the results of the FLIGHT trial?

Presented at ASH: FLIGHT trial

How would you manage a patient with PV or ET who is experiencing breakthrough thrombosis?

For example, a patient on cytoreductive therapy and aspirin BID, but suffers an arterial event, or a patient who is already on therapeutic anticoagula...

Should venous thrombosis in a patient with Behcet syndrome be treated with both immunosuppression and anticoagulation?

How would you manage OCPs in a patient who develops a VTE while on treatment?

In a patient with a medical or personal indication to induce oligomenorrhea/amenorrhea, how would you manage OCP therapy if a patient develops a VTE d...

Would you place an IVC filter in a patient with an acute PE and an absolute contraindication for anticoagulation, but negative imaging for proximal DVT?

Is there a role for anti-neutrophil antibody testing in the workup of neutropenia?

If autoimmune neutropenia already suspected, is this test informative or unnecessary?

Do hemoglobin S levels always correlate with SCD phenotype?

What is the lowest level you have seen with uncomplicated or complicated crises?

How do you decide to transition a patient with stable PNH on eculizumab to extended half-life ravulizumab?

How do you approach diagnosing a patient with Iron Refractory Iron Deficiency Anemia (IRIDA)?

Do you go straight to TMPRSS2 genetic testing or what other lab testing (e.g. hepcidin) could be helpful?

Are there patients who can forgo anticoagulation with asymptomatic, incidentally discovered subsegmental pulmonary embolism?

If there are a low-risk patients who can be monitored, how would you do so? If unprovoked, would you consider stopping anticoagulation?

What is the optimal VTE prophylaxis for hospitalized patients with COVID-19?

Should we use a different dose in critically ill patients in the ICU? When should we consider intermediate-dose anticoagulation?

What is the optimal management of a patient with refractory TTP who has had poor response to plasma exchange, steroids, rituximab, especially when caplacizumab is unavailable?

How do you manage VTE in the setting of persistent severe thrombocytopenia?

Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?

Which patients may benefit from eculizumab in refractory APS?

Do you routinely prophylactically anticoagulate patients undergoing systemic chemotherapy outside of the perioperative period?

For a patient with previously relapsed TTP but in clinical remission, what is the role of rituximab in treating asymptomatic ADAMTS13 deficiency to prevent relapse?

Rituximab has entered the treatment algorithm in the first-line setting for the initial treatment of TTP. However, in remission, the role of adjuvant ...

Is there any role for direct oral anticoagulants in the treatment of antiphospholipid syndrome?

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

How often do you utilize soluble transferrin receptor or hepcidin testing in the diagnosis of ambiguous iron deficiency, such as with concomitant anemia of chronic disease?

Does recent iron intake affect the iron panel, and if so, do you often order fasting labs in practice?

Would you anticoagulate a patient with an isolated arterial thrombosis in the setting of an inherited thrombophilia?

Does your opinion change based on the specific underlying inherited thrombophilia? The original case was a central retinal artery occlusion in a patie...

How do you evaluate an isolated prolonged aPTT in patients?

Especially in a patient without hemophilia or thrombosis history?

Would you start a patient with sickle cell disease and COVID-19 on prophylactic anticoagulation?

0 Answers available

Would you recommend anticoagulation for patients with partial false lumen thrombosis in type B aortic dissection?

Would you offer this routinely or only if specific complications arise, such as distal emboli?

Is there a role for ruxolitinib in essential thrombocythemia?

In patients who are intolerant to hydroxyurea, anagrelide and interferon

How do you manage endocrine therapy for premenopausal women with breast cancer who are heterozygous for factor V Leiden but have no history of thrombosis?