Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
If a patient had a grade 2 infusion reaction to initial dose of IV Rituximab, can you give subcutaneous Rituximab for cycle 2 or continue with IV Rituximab?
I would likely continue IV rituximab until no more infusion reactions are observed before switching to SQ.
How do you prepare patients with DLBCL on the potential need for cellular therapies after progression on first line regimens?
Once a patient is identified by the lymphoma team, they are referred to our cellular therapy service for full evaluation and discussion of CAR T cell risks, benefits, and logistics. The discussion of protocol versus commercial product, chemotherapy side effects versus CRS/ICANS, and severity includi...
Would you add Daratumumab to upfront treatment of multiple myeloma in a patient with tetraploidy on FISH?
I think the shortest answer is, "Do what you do for your patients with high-risk cytogenetics." If you ask 4 different myeloma specialists, you'll get 4 different answers: VRd for everyone, Dara-VRd for everyone, KRd just for high-risk, Dara-KRd just for high-risk... and then some (not me) will reco...
Is an elevated CRP an expected finding in an otherwise healthy patient with hemoglobin S - alpha thalassemia?
If you Google "CRP levels in sickle cell disease", you will find a number of articles reporting that CRP levels are chronically elevated in many patients with SCD. This undoubtedly reflects the chronic inflammatory state that is part of the clinical milieu of SCD. Patients with Sickle - alpha thalas...
Do you recommend starting an antiplatelet for primary prophylaxis in post splenectomy thrombocytosis given there is some increased risk of venous thrombosis?
I do not recommend routinely initiating prophylactic antiplatelet therapy for post splenectomy thrombocytosis. First, in patients without a myeloproliferative neoplasm (MPN), the increase in platelet number post splenectomy is both delayed and mild, and there is no correlation between reactive throm...
Do you consider travel as a risk factor for DVTs in the absence of any other underlying predisposing factors?
Unfortunately, there are no strong guidelines around this topic. In general, I do not count long car rides as a risk factor unless there is something extremely unusual about the trip. Most people are going to get out and stretch their legs every couple of hours. Long flights are different. There are...
Would you give IV iron for low TSAT in patients with MDS anemia who are transfusion independent but on an ESA?
Yes. The literature is replete with evidence that iron restricted erythropoiesis mitigates optimal responses to ESAs. It is overwhelmingly likely that an individual receiving erythropoietin or darbepoetin will enjoy longer intervals and dose reduction if the IRE is corrected. I administer a gram of ...
What are your triggers for BM biopsy in polycythemia vera?
We may do a BM biopsy at diagnosis for pediatric patients, but do not generally do them as part of our diagnostic work-up, especially if JAK2 mutant. However, if there is evidence for myelofibrosis (falling counts) or leukemic transformation, we would do a biopsy.
What workup and initial treatment should be considered for suspected autoimmune myelofibrosis?
Autoimmune myelofibrosis is rare and most often described in association with SLE, either concomitantly or during the course of the disease, and usually with depression of one or more of the blood counts. It is a rare occurrence with the proviso that since myelofibrosis is a reactive and reversible ...
When using daratumumab in the setting of post-transplant red cell aplasia or post-transplant immune-mediated cytopenias, do you hold the drug for certain ANC parameters?
Typically, we do not hold until below ANC 500.