Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Would you use the MIPSS-PV risk scoring to decide in decision making for cytoreductive therapy in PV?
I think the MIPSS-PV is helpful in understanding predicted overall survival and appreciating the risk of progression, the decision to cytoreduce is still routed in the classic thrombosis risk model of age plus thrombosis history. I would certainly recommend getting an NGS panel to better understand ...
Have you encountered acute kidney injury after starting eltrombopag for aplastic anemia as part of triple immunosuppressive regimen with ATG and cyclosporine?
No, I have not. Of course, cyclosporine is intrinsically nephrotoxic and is the likely candidate. Sometimes, ATG will result in renal issues as well although less frequently.
How do you approach post-transplant maintenance for patients with high-risk myeloma?
I'm migrating the discussion from another thread ("Top Takeaways from ASCO 2023") here, mainly because the premise of this question is based on new data about KPd maintenance in high-risk patients presented by Dr. Nooka and colleagues as an oral presentation this past ASCO 2023.@Dr. First Last's ins...
Do you routinely use G-CSF post-allogeneic transplant for non-haploidentical transplants?
Yes, we do. Although when we do reduced intensity transplants, we delay until after methotrexate is complete. Often counts recovery before the GCSF starts.
What is your approach to evaluating a patient with known rheumatologic disease and elevated free kappa:lambda ratio, but no evidence of monoclonal immunoglobulins?
The information given is a bit sketchy. But assuming a bone marrow biopsy has been done and there is no evidence of malignancy, I would adopt a watch-and-wait approach. If no bone marrow has been done, I would keep an eye on the appropriate blood tests and in collaboration with a hematologist do a b...
Would you offer a bone marrow biopsy to the patient with normal CBC and low MDS-associated mutation burden found on NGS?
Generally speaking, we don't perform NGS sequencing for MDS-associated somatic mutations in individuals with normal blood counts. However, the issue does arise when cancer patients undergo blood-based sequencing for other reasons, for example. And, in the future, we may see more mutation testing in ...
How common are nasal telangiectasia in patients with systemic sclerosis?
Telangiectasias, particularly “matted’’ ones are often seen in patients with Systemic sclerosis (SSc), both limited and diffuse cutaneous. They can also be seen in patients with MCTD, UCTD with SSc features, Lupus or Dermatomyositis (often periungual). In SSc, they are most commonly on the face and ...
How do you manage me anticoagulation in a patient with May Thurner Syndrome, who does not have history of thrombosis, and becomes pregnant?
Watch dimers, if neg, no anticoagulation; if positive, anticoagulation.
How would you work up an elevated copper level without cytopenias in a patient with history of bariatric surgery not on supplements or using copper utensils?
Would make sure they are not on supplements as these are often recommended post bariatric surgery. Otherwise, not sure of a connection with bariatric surgery. Would check ceruloplasmin level to rule out Wilson's disease. A low copper level is more likely and can cause leucopenia and sideroblastic an...
What post-auto maintenance therapy do you recommend for patients with high-risk multiple myeloma?
This is tough. You want each particular risk group to correspond to a maintenance treatment that is likely to benefit the patient - not too much nor too little. The definition of high risk has changed from one single characteristic or one cytogenetic abnormality to a more additive model such as the ...