Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Is there benefit to aggressively treating hemochromatosis in a patient who has already progressed to cirrhosis at the time of diagnosis?
The short answer is yes, there is a benefit to treating iron overload in a patient with hereditary hemochromatosis (HH) with cirrhosis. HH involves at least five mutations, most commonly in the HFE gene (common variants include C282Y and H63D), leading to hyperabsorption of iron and progressive accu...
For primary CNS lymphoma, when do you refer for whole brain radiation therapy (WBRT)?
When data are limited, consensus guidelines tend to rely on the personal clinical experiences of the guideline committee members. That may explain the NCCN guidelines. Recently, remarkable progress has been noted in the treatment of CNS lymphoma with drugs alone. Ibrutinib is particularly effective ...
How would you approach a referral for concern for hemochromatosis with ferritin elevation but otherwise normal iron studies?
Interesting questions, but lack of specifics about the degree of elevation and what constitutes normal iron studies makes it difficult to directly answer this question. However, there are well-recognized causes of elevated ferritin due to non-iron overloaded conditions, including increased apoferrit...
How would you approach the management of a patient with elevated iron saturation (60%) and ferritin (500s) with negative genetic testing for hemochromatosis?
I would approach this clinical scenario in the following manner: Always starting with good medical and family history first. Is there any history compatible with secondary hemochromatosis (i.e., history of blood or multiple iron transfusions)? Could the patient be tested for other non-282Y genetic ...
What is your treatment approach for MAG antibody associated polyneuropathy?
When patients have a classic Distal acquired demyelinating sensory (DADS) Neuropathy phenotype (by clinical +/- EDX criteria), typically an SPEP/IFE is checked first, and if an IgM monoclonal gammopathy is observed, then I typically check MAG antibodies at that point (if clinical and EDX features ar...
When treating a patient with classic early stage diffuse large B-cell lymphoma (Stage I/II), when is it appropriate for patients to receive 3 versus 6 cycles of R-CHOP chemotherapy when the treatment is followed by ISRT?
The SWOG 8736 study included patients with stage I (bulky or non-bulky) and nonbulky stage II aggressive non-Hodgkin lymphomas (mostly DLBCL). Bulky was defined as a mediastinal mass >1/3 maximal chest diameter or any mass > 10 cm. Patients were randomized to 8 cycles of CHOP or 3 cycles of CHOP + R...
How do you approach imetelstat therapy in MDS patients with baseline neutropenia or thrombocytopenia?
Given the fact that the major treatment-emergent adverse events noted on the phase III IMERGE study in the imetelstat-treated arm were neutropenia (68% Grade 3+ tox) and thrombocytopenia (62% Grade 3+ tox), it makes it somewhat difficult to utilize imetelstat (Platzbecker et al., PMID 38048786) in p...
How would you manage HHT with ongoing epistaxis despite IV bevacizumab, with a history of superficial thrombosis?
This is a complex situation with a complex answer, and the patient would likely benefit from establishing care at one of the 30 HHT centers of excellence for a more thorough evaluation. If the patient mentioned has only had cautery, we would consider them seeing an ENT at an HHT center of excellence...
What are your top takeaways from ISTH 2025?
MAYARI trial - this trial was a single-arm trial for "non-severe" iTTP (excluding patients with significant cardiac or neurologic involvement) where PLEX was only used as a rescue therapy. Patients were started on caplacizumab and immunosuppression with steroids and rituximab. A large number of pa...
How do you manage persistent cytopenias after FCR chemotherapy for treatment of CLL?
For persistent cytopenias after FCR, the initial approach would be supportive care. If no recovery after 12 weeks, consideration should be for a bone marrow biopsy to evaluate for aplasia, an autoimmune process like PRCA, or early MDS. The therapy after the bone marrow would be based on the result. ...