Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
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...
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...
What is your approach to bone imaging in MGUS?
Excellent question. For low-risk MGUS (M-spike <1.5 g/dL, normal serum free light chain ratio, and an IgG type protein), it is reasonable to forego any bone imaging in the absence of any relevant bone-related symptoms. The rate of bone involvement in patients with an M-spike of 1.5 g/dL was noted to...
How do you approach the management of a patient with symptomatic iron deficiency anemia who is intolerant of iron?
Oral iron will not work. I would bet my last dollar there was no anaphylaxis but rather an imprudently treated minor infusion reaction which is the cause of ostensible “anaphylaxis” over 99% of the time. You can’t verify that it was real because I can assure you: It was not. They did not do a trypt...
Do you routinely refer young patients with iron deficiency anemia for GI evaluation?
The answer is no, I do not. However, if after iron repletion deficiency persists, then I do. But as for pregnancy, unless there has been a precipitous and proven drop, I would definitely not do a GI workup during pregnancy.
How would you manage symptomatic iron deficiency in patients with PV on frequent phlebotomies?
While iron deficiency by itself is not harmful, if someone has symptomatic iron deficiency, you could consider them intolerant to phlebotomies, and start a cytoreductive agent. Then, over time they can replete their iron stores. In some patients who are very symptomatic from their iron deficiency, I...
How soon after initiating oral anticoagulation therapy for atrial fibrillation can it be interrupted for surgery or procedures?
As with most things medical, multiple answers. If a patient walks into my office for preOp "clearance" and behold, they are in atrial fib, but asymptomatic, then it would depend on the urgency of their surgery. If elective, then you have time to work up his atrial fib and look for a reversal cause (...