Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Will you recommend pirtobrutinib following a prior covalent BTKi in patients with cardiac comorbidities?
In the MCL patients treated on the BRUIN trial, treatment was well tolerated in general with a low rate of treatment discontinuation or dose reduction. As far as cardiac toxicities, no grade ≥3 treatment emergent AEs of hypertension were observed. Atrial fibrillation/flutter (AF) was reported in 6 (...
For patients with a history of pregnancy loss, do you evaluate for PAI-1 polymorphisms as part of a thrombophilia workup?
I do not.The relationship between PAI-1 polymorphisms and thrombosis is complicated, and general guidance suggests against assessing for PAI-1 overexpression as part of a thrombophilia workup. While there is some data to suggest an association between PAI-1 polymorphisms and pregnancy loss, ALIFE2 s...
Would you consider prophylactic anticoagulation for May-Thurner syndrome in pregnancy if prior endovascular intervention has been completed?
In general, I have a very low threshold to initiate prophylactic anticoagulation in pregnancy. For a patient with a history of May-Thurner that has been endovascularly corrected and who has been maintained off of anticoagulation without issue, I would have a risk-benefit discussion about prophylacti...
For pediatric patients with iron overload (high ferritin and transferrin saturation), do you perform HFE screening first, or proceed to non-HFE gene sequencing upfront to evaluate for HJV mutation as well?
Because there is no recommended "screening" scenario for iron overload in pediatrics (especially with no family history), the question for me revolves around "why did the patient get tested in the first place?" If it were a routine screen for iron deficiency, which affects millions of children at an...
How do you approach management of a patient with mast cell leukemia?
Mast cell leukemia (MCL) is a rare and aggressive subtype of systemic mastocytosis defined by ≥20% mast cells in the bone marrow aspirate. A recent multicenter analysis of 92 patients with MCL had a median overall survival (OS) of 1.6 years. Midostaurin was the most common first-line therapy (45% of...
What are your top takeaways in Classical Hematology from ASH 2025?
My top 3 takeaways in classical hematology:1) ITP - much controversy at the education program session about the draft 2025 guidelines, where TPO mimetic + steroids is going to be recommended in the front line. There does not appear to be compelling new data that supports the revision of this guideli...
Should other treatment options be considered for MALT lymphoma if the lacrimal gland will be included in the radiation field in a patient with Sjögren's disease?
The orbit is the second most common site of origin for extranodal marginal zone lymphoma (MZL). Involved orbital structures include the bulbar and/or palpebral conjunctiva, lacrimal gland, and periorbital soft tissues. Patients with Sjögren’s syndrome (SS) are at increased risk for developing extran...
For biopsy proven extranodal marginal zone lymphoma involving two small bilateral lung nodules, would you consider definitive treatment to both nodules with radiation therapy?
As is often the case with questions addressed to theMednet, one would like to know a little more about the patient before making a definitive recommendation, age, symptoms, general medical condition, etc. Also, the volume of lung that would need to be treated. (Would not rx lymphatics). However, I'l...
For stage III-IV Hodgkin's lymphoma, would you consider consolidative radiation for bulky disease after a complete response was seen using N-AVD per the S1826 trial?
I would offer consolidative radiation only for PET-positive residual disease.
Do you continue to check tryptase levels in your patients with idiopathic anaphylaxis despite normal levels >5 on repeated checks?
Baseline serum tryptase levels have been reported to be quite stable in the vast majority of patients, but can vary more in people with HaT or mastocytosis. With a bST <8 ng/ml, there is no obvious reason to continue to check it. However, even with normal bST, the Practice Parameters recommend furth...