Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Do you treat secondary erythrocytosis caused by SGLT2 inhibitor?
I have seen this once, and stopped the SGLT2 inhibitor, and recommended they identify an alternative strategy to treat his DM. It seemed to help overall.
How do you choose bridging therapy prior to CAR-T leukapheresis?
There is a lack of uniform clarity around terminology here. To avoid confusion, I prefer using "debulking" for treatment that is administered prior to T-cell apheresis, and "bridging" for treatment administered after apheresis to bridge the patient during manufacture to maintain disease control prio...
Do you use GCSF for a patient with MDS with excess blasts and neutropenia?
It really depends on what you are trying to achieve: If the goal is to get the patient to a curative allogeneic transplant, then the answer is no. If the goal is to get an elderly frail patient to break fever and leave the hospital to spend some quality time with family, then the answer is yes!
How do you work up a young patient with increasing ferritin and normal TSAT without infectious, inflammatory, or liver disorders?
This is a tough one. If the ferritin is increasing and the TSAT is normal and there is no evidence of hemochromatosis, the ONLY possible explanation is some underlying morbidity, inflammatory, rheumatologic, malignant, or infectious is present. In pediatrics, HLH (hemophagocytic lymphohistiocytosi...
What is the treatment of choice for mixed phenotype ALL?
These are difficult to treat. The limited available data suggest that an ALL–like regimen followed by HSCT may be recommended. If no response is achieved, you could try a myeloid-like strategy. For T/Myeloid, combining asparaginase with AML therapy (FA + PEG or Capizzi II) could be an option. The sp...
How do you utilize p53 NGS testing in your treatment planning for patients with CLL?
When I approach consideration of treatment, it is clear that TP53 mutation or del(17)(p13) chromosome region on interphase cytogenetics identifies a group of patients at risk for progression after treatment with a venetoclax containing regimen and also to a lesser extent BTKi (ibrutinib/acalabrutini...
Can APLS cause a false positive HIT ELISA?
Yes, that has been reported: Pauzner et al., PMID 19291166.
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...