Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How soon after initiating oral anticoagulation therapy for atrial fibrillation can it be interrupted for surgery or procedures?
As with most things medical, multiple answers. If a patient walks into my office for preOp "clearance" and behold, they are in atrial fib, but asymptomatic, then it would depend on the urgency of their surgery. If elective, then you have time to work up his atrial fib and look for a reversal cause (...
Is there specific data on using luspatercept for sickle beta+ thalassemia with transfusion-dependent anemia?
The mechanism of action of luspatercept is to trap and remove ligands of the TGF beta superfamily of ligands, specifically the growth and development factors (GDFs) 11 nd 15. This allows more maturation and differentiation of the erythroid precursors, and an increase in red cell production and relea...
What factors drive your selection between tafasitamab and epcoritamab for a patient with relapsed/refractory follicular lymphoma?
For an older patient or a patient with comorbidities, if one is prioritizing outpatient simplicity, tafasitamab + R² delivers an NCCN category 1 benefit with substantially lower acute immune toxicity. If CD19 CAR-T is the next planned therapy, however, the CD19-targeting overlap is a consideration t...
Would you supplement iron for low iron studies in absence of anemia?
The answer is absolutely and positively. Iron deficiency causes symptoms independent of anemia which include fatigue, brain fog, restless legs syndrome, and pagophagia and other forms of pica. You simply cannot dignify waiting for overt iron deficiency to develop in someone with symptomatic iron def...
What is the treatment strategy and priority in a patient with newly diagnosed Hodgkin lymphoma but HLH at presentation?
Would be good to have more details about the patient's medical condition and organ function. How definitive is the HLH diagnosis as against Hodgkin's with B symptoms? Malignancy-associated HLH at diagnosis is due to cytokines/chemokines produced by the tumor cells, so the major part of the therapy i...
For cancer patients with suspected PE, how should the HYDRA trial--which proposes using the YEARS algorithm is as safe as a CTPA-only approach--change the diagnostic workup?
The YEARS algorithm was originally developed to determine which adults with suspected pulmonary embolism (PE) can safely avoid computed tomographic pulmonary angiography (CTPA). It uses three criteria — clinical signs of deep-vein thrombosis, hemoptysis, and PE judged the most likely diagnosis — com...
Should platelet transfusions be considered for anti-platelet agent reversal in patients with major bleeding?
Patients on plavix and/or aspirin are at risk for bleeding whether in relation to surgery or bleeding from the gi tract. Much like the management of patients on anticoagulation temporary reversal of antiplatelet drugs is only achieved by normalizing platelet function. This is the same principle used...
If blood counts are being checked during concurrent chemoradiation, is there a number at which point you would recommend a radiation treatment break?
I’ll let the platelets go as low as 10K before stopping. I lean heavily on the rate of decline to intervene with a break sooner than the absolute numbers if heading for trouble and later if decline is slow and at reaching the end of treatment.
For pregnant nontransfusion dependent beta thalassemia patients, when would you consider ESAs for worsening anemia?
Non-transfusion-dependent thalassemia (NTDT) patients tend to have elevated erythropoietin (EPO) levels already, proportionate to their degree of anemia. The basic pathophysiology of thalassemia is ineffective erythropoiesis (IE), in which proliferation, in response to high EPO levels, is already su...
What could explain failure to luspatercept in patients with transfusion-dependent beta thalassemia?
Luspatercept works by trapping TGF beta ligands (GDF 11 and 15) and optimizing maturation and differentiation of erythroid precursors, thus facilitating increased output of red cells.In individuals who have beta zero-beta zero thalassemia, this must mean that the cells coming out would contain hemog...