Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How do you counsel patients with minimally symptomatic factor VII deficiency about procedures and periprocedural management?
Partial Factor VII deficiency is relatively easy to discover (long PT/INR) but the bleeding risk tends to be over-estimated. The available evidence (Peyvandi et al., PMID 22321862) suggests that significant bleeding is uncommon unless the factor VII level is less than about 15% of normal. I would th...
Do you account for the effect of coffee on platelet aggregation studies?
Although recommendations from the International Society of Thrombosis and Haemostasis (ISTH) [1] suggest that individuals should avoid caffeine for at least 2 hours before blood is drawn for light transmission platelet aggregation studies, (and be fasting, be rested for 30 minutes, and avoid smoking...
What is your approach for choosing between Imetelstat and Luspatercept in managing MDS related anemia?
In the past 18 months, between the COMMANDS trial looking at Luspatercept in expanded indications beyond just patients with MDS-RS and the IMerge trial looking at the use of Imetelstat in patients with low-risk MDS, we now have many more options for these patients.The COMMANDS trial looked at Luspat...
For patients with a JAK2 positive myeloproliferative neoplasm, do you always perform a bone marrow biopsy at diagnosis?
A bone marrow biopsy is very helpful at diagnosis for patients with MPN as it can clearly establish a diagnosis. Although many times we can guess a diagnosis by looking at peripheral blood counts, we can often miss pre-MF or overt MF without a bone marrow biopsy. For young patients especially, a bon...
What is your approach to screening a cancer survivor for iron overload, and what is your treatment of choice?
Excellent article on this topic: Baskin-Miller et al., PMID 39096194
How do you monitor and manage minimal residual disease (MRD) in patients with core-binding factor (CBF) AML who are in remission post-induction and consolidation therapy?
For the purposes of this question, we will presume this refers to patients who are MRD-negative by a PCR-based methodology and have completed induction chemotherapy and consolidation.Puckrin et al., PMID 31896684 reported on 114 patients with CBF-AML who were treated with intensive chemotherapy and ...
How frequently would you consider IV iron treatment for ongoing iron loss and severe iron deficiency anemia?
Absolutely. You first want to estimate and replace their iron deficit. For patients who are very anemic, they can start at 2-3 grams deficit. I usually don’t give more than 1500 g of iron dextran at one time, but I will have no concern about doing 1000 or 1500 mg weekly until I have replaced their d...
What is your preferred first line treatment for patients with high risk MDS who are not candidates for transplant?
My choice of first-line therapy for high-risk MDS patients that are not transplant candidates tends to still be a hypomethylating agent (HMA). I send a myeloid molecular profile on all my MDS patients and use the p53 mutation status to make a decision regarding azacitidine vs. decitabine use. For pa...
How would you manage LPL with associated AL amyloidosis?
My approach here would depend upon the nature, impact, and severity of the amyloid. Is the LPL IgG or IgM secreting? Is the amyloid causing immediate physiologic harm (renal, cardiac) or asymptomatic radiographic deposits? How much lymphoma and amyloid, respectively? Treatment options include Benda,...
For a relapsed AML patient who has previously received 7+3 followed by HIDAC consolidation, how do you choose between FLAG-IDA or MEC re-induction?
In general, there is no "optimal" intensive salvage regimen for relapsed/refractory AML failing prior 7+3 and HIDAC consolidation. Prior comparisons of cytotoxic regimens have demonstrated no clear "winner" so it is based partly on clinical experience. At our center, I tend to prefer adding cladribi...