Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How would you manage a young patient with HL who develops HF (EF < 30%) after 4 cycles of A+AVD who obtained a PET2 CR?
This is a tough case, and the management would depend on the extent of disease. Assuming that this is advanced stage HL, given the use of BV+AVD, I would be in favor of completing 6 cycles of therapy with a non-anthracycline-based regimen. You can consider consolidative radiation, but this would nee...
What is your approach to the management of essential thrombocytosis in a woman planning to start a family?
This is an important question because it directly addresses what it means for a patient to have an MPN, and what it means for the physicians who treat them. The first is diagnosis: what is essential thrombocytosis (ET)? Some “experts” state that it is “related” to polycythemia vera (PV), or represen...
Would you treat the mandible if the patients has osteonecrosis from zoledronic acid but also multiple myeloma in this region, biopsy proven?
Plasma cells can be seen in mandible biopsy without myeloma in that region. Have had a similar patient. However, if the patient has confirmed myeloma relapse elsewhere or systemically then would treat relapse with chemo. Denosumab or zometa is contraindicated due to confirmed osteonecrosis. Not sure...
How would you manage a case of subcutaneous panniculitis-like T cell lymphoma (A/B) who is already on steroids and methotrexate for autoimmune disease?
First, I would want to be assured that the diagnosis is truly panniculitis T cell lymphoma and not lupus profundus. The two can be hard to differentiate microscopically with T cell gene rearrangement positive in the lymphoma. If the diagnosis is lupus profundus, this would be managed as per rheumato...
How would you optimally manage a small solitary plasmacytoma of the alveolar ridge, including minimizing the risk of dental toxicity?
The alveolar ridge is an osseous structure (extension of the mandible and maxilla) that houses the sockets of the teeth. Assuming an appropriate work-up demonstrates no evidence of multiple myeloma (bone marrow biopsy, PET-CT/MRI, laboratory work, etc.), a plasmacytoma arising in this region would b...
Is a bone marrow necessary in patient with splenomegaly and polycythemia vera?
Yes. Bone marrow is necessary in a patient with polycythemia vera and splenomegaly. There is a possibility of missing ET or associated primary or secondary myelofibrosis. The only way to distinguish between the three bcr-abl negative MPN namely MF, ET, and PV is by performing a bone marrow biopsy an...