Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is the treatment strategy and priority in a patient with newly diagnosed Hodgkin lymphoma but HLH at presentation?
Would be good to have more details about the patient's medical condition and organ function. How definitive is the HLH diagnosis as against Hodgkin's with B symptoms? Malignancy-associated HLH at diagnosis is due to cytokines/chemokines produced by the tumor cells, so the major part of the therapy i...
How would you approach mantle cell lymphoma in very elderly patients?
For patients who are very elderly, my approach depends on the patient's performance status, other comorbidities, disease features/disease behavior, and indications for treatment. There are patients with MCL who can be observed at diagnosis (those with leukemic non-nodal disease but also those with l...
For cancer patients with suspected PE, how should the HYDRA trial--which proposes using the YEARS algorithm is as safe as a CTPA-only approach--change the diagnostic workup?
The YEARS algorithm was originally developed to determine which adults with suspected pulmonary embolism (PE) can safely avoid computed tomographic pulmonary angiography (CTPA). It uses three criteria — clinical signs of deep-vein thrombosis, hemoptysis, and PE judged the most likely diagnosis — com...
Should platelet transfusions be considered for anti-platelet agent reversal in patients with major bleeding?
Patients on plavix and/or aspirin are at risk for bleeding whether in relation to surgery or bleeding from the gi tract. Much like the management of patients on anticoagulation temporary reversal of antiplatelet drugs is only achieved by normalizing platelet function. This is the same principle used...
Would you stop current immunosuppressive therapy or delay starting immunosuppressive therapy in a patient with aplastic anemia who has been infected with COVID-19?
This is an interesting question. Based on personal communication (Italy, Germany, Israel), we have not seen increased risk for pediatric patients with hematological diseases and COVID-19. There was one case reported in China, but it was inconclusive (nearly 50 y.o. patient with aplastic anemia—seeme...
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
At our institution, we have comprised a multidisciplinary team to help treat these patients. The team or "HLH task force" as we like to call ourselves is comprised of a clinical immunologist, rheumatologist, dermatologist, critical care physician, hepatologist, BMT attending/hematologist, infectious...
If blood counts are being checked during concurrent chemoradiation, is there a number at which point you would recommend a radiation treatment break?
I’ll let the platelets go as low as 10K before stopping. I lean heavily on the rate of decline to intervene with a break sooner than the absolute numbers if heading for trouble and later if decline is slow and at reaching the end of treatment.
Would you treat patient with early stage unfavorable classic Hodgkin lymphoma with 6 cycles instead of 4 cycles of Nivo-AVD to avoid mediastinal radiation in young female?
I would tailor the number of cycles to the clearance of PET positivity. If one is considering stopping at 4 cycles, I would do a PET scan after 2 cycles and only stop at 4 if it was negative. If it is positive after 2 cycles, I would repeat the PET scan after 4 cycles. If it is still positive, an al...
How do you approach immediate management of paraspinal extramedullary hematopoiesis in patients with transfusion-dependent thalassemia when lesions are enlarging or causing neurologic symptoms?
In general, the goal of transfusion therapy in transfusion-dependent thalassemia (TDT) is to suppress ineffective erythropoiesis. It is the rationale for maintaining a higher pre-transfusion hemoglobin level, at 9.5-10.5 g/dl, well above the general threshold for PRBC transfusion used in oncology pa...
For pregnant nontransfusion dependent beta thalassemia patients, when would you consider ESAs for worsening anemia?
Non-transfusion-dependent thalassemia (NTDT) patients tend to have elevated erythropoietin (EPO) levels already, proportionate to their degree of anemia. The basic pathophysiology of thalassemia is ineffective erythropoiesis (IE), in which proliferation, in response to high EPO levels, is already su...