Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What workup do you perform to evaluate for underlying triggers/associated conditions in a pediatric patient with autoimmune hemolytic anemia?
The diagnostic workup that I would recommend in order to rule out a possible underlying condition includes the following: Extensive red blood cell typing in anticipation of possible transfusion. Further immune-haematological investigations: C3, C4, CH50 Auto-antibodies (ANA, anti DNA), antiphosp...
How would you manage an incidental catheter-related thrombosis in a functioning dialysis catheter?
If the patient is asymptomatic and the catheter is functioning well, I recommend starting anticoagulation.If the patient develops symptoms, he or she should still be anticoagulated but the catheter removed. Anticoagulation options in ESRD patients include Coumadin, Eliquis (my preference is a dose o...
Would you consider use of upfront BV plus nivolumab to treat Hodgkin Lymphoma in elderly patients unable to receive standard chemotherapy?
I would definitely consider BV/Nivo in frontline settings for elderly patients if no trial is available.Prognosis is worse in elderly HL for several reasons - SOC chemotherapy is not well tolerated and biology of the disease is different (mixed cellularity being prevalent and more frequent EBV posit...
How would you approach treatment of a bulky stage II DLBCL in a patient >80 with a contraindication to anthracyclines but otherwise good performance status?
The management of DLBCL in the elderly, particularly those unfit for standard anthracycline-based chemoimmunotherapy, is an area of unmet need and clinical challenges. While there is no single standard of care, and participation in clinical trials designed for this patient population is encouraged, ...
Do you check pertussis serologies when sending labs for antiphospholipid syndrome?
The short answer is no. I do not check pertussis antibodies when evaluating patients for anti-phospholipid syndrome. A slightly longer answer is still no and, for example, a review published in the Annals of Rheumatic Diseases by Ron Asherson in 2003 discussing the relationship between various infec...
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?
Until we know more, it seems prudent to avoid the AstraZeneca and J&J vaccines, particularly if there is a history of HIT. The Pfizer and Moderna vaccines use a different technology and have not been associated with the thrombosis/thrombocytopenia syndrome.
When can defibrotide be discontinued before the 21-day treatment course is completed in a pediatric patient with SOS?
There is no data to support the 21-day use in everyone. Also, some patients might even need a longer course than the prescribed 21 days if manifestations are ongoing. A good general rule of thumb would be to continue (provided no bleeding or other toxicities) for 3-5-7 days post resolution of ong...
Do you offer maintenance rituximab in transplant ineligible patients with mantle cell lymphoma?
The data on the role of rituximab maintenance therapy in transplant ineligible patients with mantle cell lymphoma are not straightforward to interpret. The most often cited experience (Kluin-Nelemans, et al., PMID 22873532) is a complicated study with two randomizations: induction therapy was either...
What additional testing, if any, should be performed for an adolescent patient with heavy menstrual bleeding and a negative von Willebrand disease evaluation?
I presume that the adolescent with heavy menstrual bleeding whose von Willebrand panel is negative has already had a CBC and baseline coagulation screen (prothrombin time, activated partial thromboplastin time, and fibrinogen or thrombin time) performed. If that is the case, I would suggest evaluati...
Would you start TKI therapy in a patient with new diagnosis of T-ALL without BCR-ABL gene rearrangement on FISH but found to have very low level p190 transcript on RT-PCR?
I would not. I don't necessarily have any evidence to support this, so this is simply an opinion. I have seen this a couple of times in my clinical practice. If there is truly BCR-ABL present in this patient's leukemia, the level of it would have to be extremely low to only be detectable at this rep...