Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is your surveillance protocol for patients with common variable immunodeficiency receiving chronic IVIG therapy?
No target IgG level per se- dose/interval should be titrated to clinical condition. In general, trough IgG on treatment should be higher than 500 mg/dL, or 500 mg/dL higher than baseline. Most patients will not be in optimal clinical condition (minimal fatigue, arthralgias, absence of chronic cough,...
Do you use MRD testing to guide maintenance therapy discontinuation in newly diagnosed non-high risk myeloma patients?
Patients with high-risk myeloma, whether defined by the IMS/IMWG or the somewhat controversial functional criteria, generally require ongoing treatment given the agents we have available; otherwise, they quickly relapse. It's easy to understand that there must be patients on the other end of the spe...
At what lab values (ferritin, TSAT%) would you offer IV iron therapy to patients with restless leg syndrome?
1. I am hopeful that practitioners will start understanding that ferritin alone is not enough to assess iron because of its acute phase reactivity. I like to order iron parameters after a 5-9 hour fast so the serum iron is not speciously elevated and get a ferritin and TSAT. If the ferritin is <30 a...
For patients with SLE, is there an ANC level for which you would hold or adjust hydroxychloroquine in an asymptomatic patient?
Leukopenia most often as lymphocytopenia, of course, is not unusual in lupus. Total WBC less than 4000 is an ACR classification criteria for the disease as is ALC less than 1500 on two occasions. SLICC disease classification requires ALC less than 1000. Total WBC < 3000 generates SLEDAI points. On t...
Is there any benefit to checking serum viscosity in patients with autoimmune disease and headaches/migraines to see if aspirin or clopidogrel may be beneficial?
The serum viscosity test measures the time required for the serum to flow through a calibrated capillary tube under controlled pressure. Clinically significant elevations in viscosity (≥2.5 centipoise, normal range 1.4 - 1.8 cP) can cause symptoms and are most commonly seen in hyperviscosity syndrom...
What is your preferred frontline treatment for CLL in young patients < 50 years old?
For younger patients, just like older patients with CLL, my preference for frontline treatment is based on genomic characteristics, fitness, and patient preference. I also prefer clinical trials over standard therapy, when available. For those young fit patients with IGHV mutated disease, the option...
How would you counsel a woman with a strong family history of thrombosis about oral contraceptives?
This can be a complex question for which there are likely no specific data or guidelines upon which to base a recommendation. ASH has published guidelines on thrombophilia testing in VTE (Middeldorp et al., PMID 37195076). They specifically recommend against testing prior to COC prescription. The ra...
Under which circumstances would you prefer ropeginterferon over hydroxyurea for patients with Polycythemia Vera?
The approval of ropeginterferon (Besremi) for the treatment of polycythemia vera (PV) without any restrictions was a welcome event for PV patients and their physicians. First, because this drug selectively targets the JAK2-mutated hematopoietic stem cell (HSC) responsible for PV and can produce comp...
How would you treat a patient with POEMS syndrome with severe debilitating neuropathy?
This is an important question. Peripheral neuropathy is one of the mandatory criteria for a diagnosis of POEMS syndrome, and can range from mild paresthesias to devastating, wheelchair-bound neuropathy (Dispenzieri, PMID 37732822). What makes POEMS uniquely gratifying is that effective therapy can l...
In patients with Philadelphia-negative ALL who are transplant ineligible, is there any data to guide the duration of maintenance POMP therapy?
To my knowledge, there have not been any prospective trials in the modern era that specifically address the issue of the duration of maintenance therapy in adults with ALL.Most regimens that have been studied provide a timeframe over which maintenance therapy should be administered, and nearly all h...