Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is your approach to symptomatic superficial thrombosis of the pelvic veins occurring in the immediate postpartum period?
I would strongly consider anticoagulation in this scenario given the high risk of thrombosis in the postpartum period.Generally, there is a low threshold to place patients on prophylactic dose anticoagulation for six weeks postpartum (personal history of thrombosis, inherited thrombophilia) given th...
Would you recommend anticoagulation in subsequent pregnancies after symptomatic postpartum R ovarian vein thrombosis?
The 2018 ASH guidelines recommend the following: For women not already receiving long-term anticoagulant therapy who have a history of VTE, the panel makes the following recommendations: Unprovoked VTE (strong recommendation, low certainty): and provoked VTE, hormonal risk factor (strong recommendat...
Would you continue venetoclax indefinitely/until disease progression in patients treated with upfront venetoclax for TP53 mutated CLL?
First of all, for the del(17)(p13.1) and/or TP53 mutated CLL patients, venetoclax + obintuzumab may not be the best option based upon data from the CLL14 trial showing early PFS in this group as compared to what has been demonstrated in both up-front ibrutinib and acalabrutinib studies. However, we ...
How does your approach to subsegmental PE differ from segmental PE both diagnostically and therapeutically?
My approach to subsegmental PE and segmental PE generally tends to be very similar. I am aware of the CHEST guidelines which indicate patients can safely be observed with subsegmental PE, but like a recent study showed (Rouleau et al., PMID 37531107), uptake of these guidelines is slow and many pati...
How would you evaluate a pediatric patient referred to rule out cancer due to an isolated significantly elevated vitamin B12 level?
What is your approach to managing follicular lymphoma with central nervous system involvement?
Not really an expert on this issue. Fairly uncommon to have a follicular lymphoma-associated CNS disease. Our usual is for high-dose methotrexate, Temodar, and rituximab. Potentially followed by autologous stem cell transplant.
How do you manage anticoagulation in a patient with DVT from likely malignant mechanical obstruction?
This is a very difficult situation to manage. Would promptly initiate therapeutic anticoagulation as long as no increased risks for bleeding. The surgery to remove the uterine mass is likely urgent. I would confirm with gynecologic oncology (or the team planning on removing the mass) that it is not...
For patients with Stage IIIB or IV HD flowing Bv-AVEPC with initial large mediastinal adenopathy, how can we avoid ISRT?
It is true that on the clinical trial AHOD1331, patients who presented with large mediastinal adenopathy received radiation therapy as did patients who were slow early responders (Deauville 4 or 5 after two cycles of therapy). It is noteworthy that 3-year event-free survival was extremely high for a...
How would you determine the safety of anticoagulation in patients with evidence of cerebral microhemorrhages who present with acute stroke secondary to cardioembolism?
This question assumes that the patient already had an MRI showing microhemorrhages. The Boston criteria provide guidelines for the number of microbleeds, associated superficial siderosis, or major hemorrhage to make the diagnosis of cerebral amyloid angiopathy. I would also assume that at least some...
Is there a role for CRS prophylaxis with tocilizumab during bispecific T cell engager initiation for myeloma?
I would not use Toci prophylactically. I see more problems with ICANS/confusion in MM bispecifics, and this responds to steroids, not Toci, or resolves on its own.