Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
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?
AVN in SLE patients is common, most often in the context of glucocorticoid use. Thus, in this case, there is no evidence that APLAs are the etiology. Moreover, to the best of my knowledge, there is no evidence that primary prevention with aspirin in the setting of APLAs is effective. So I would not ...
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?
This is a difficult question. I would make sure that the patients had adequate "stress tests" of their hemostatic system before concluding they have no bleeding history. For example, it is difficult to estimate the bleeding risk if somebody has never had surgery or pregnancy and has been on OCP sinc...
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?
Part of the reason the patient may have controlled disease could be the hydroxyurea and so stopping that therapy might not be best for the patient's disease. Also, many patients on hydroxyurea can still get their partner pregnant. So, I would only consider stopping/holding it if the patient is havin...
What is the recommended radiation treatment volume for a patient with orbital DLBCL who achieved a CR to chemotherapy?
I suggest consulting the excellent guideline from the ILROG. There is a difference between Primary Intraocular Lymphoma and Orbital (Ocular Adnexal) Lymphoma. The guideline also describes which patients can be managed without irradiation of the entire orbit.
What is your approach to BK hemorrhagic cystitis not responding to cidofovir?
BK hemorrhagic cystitis can range from completely asymptomatic infection (with positive BK viremia and viruria by PCR) or grade 0 to massive macroscopic hematuria requiring instrumentation for clot evacuation and urinary obstruction requiring bilateral nephrostomy tubes for urine diversion (grade 4)...
For a patient with PE undergoing procedures like port placement in the first month, how do you manage anticoagulation?
Due to their convenience, efficacy, and safety, I think direct oral anticoagulants (DOC) are the agents of choice for most cases of PE, DVT, or chronic prophylaxis. As per the package insert for Apixaban, for moderate or high risk invasive procedures, stop 48 hrs in advance, and for low risk, stop 2...
Which patients with acute promyelocytic leukemia do you consider maintenance after completing consolidation?
Before we address the role of maintenance in APL, several principles are important to note. First, APL is now a highly curable disease with contemporary therapeutic strategies. Second, we now divide patients into low-risk and high-risk based solely on the presenting WBC (< or =10,000/uL vs >10,000/u...
How do you advise patients with sickle cell disease on contraception?
According to both the "ASH Pocket Guidelines" and the National Heart Lung and Blood Guidelines for health maintenance in Women with sickle cell disease, progestin only and barrier methods of contraception are the preferred recommendations for contraception. Combined hormonal agents can be considered...
How do you approach the management of GVHD prophylaxis in the setting of severe infection?
GVHD prophylaxis the 1st ~ 3 months after alloSCT is paramount and immunosuppression withdrawal might cause GVHD which can in turn exacerbate or cause infection given the need of corticosteroids to control it. Having said that, case-by-case management is important. As an example, alloSCT using a PTC...
Would you consider thrombophilia testing in a pregnant patient with VTE?
I would not check antiphospholipid antibodies in a pregnant woman with thrombosis unless she had a history of autoimmune disease or other concerning findings. However, if it were checked, I would make sure that it is a true positive. DOACs often cause a false positive LAC. I have had patients with f...