Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Do you consider testing and treating IDA in unexplained thrombocytopenia?
Iron deficiency often causes thrombocytosis, and in fact, probably is the most common cause of reactive thrombocytosis encountered in clinical practice. With very severe iron deficiency, thrombocytopenia can be seen. I have seen it in rare patients presenting with hemoglobin levels about 3 gm/dL or ...
How do you counsel an otherwise healthy patient on how soon they can go back to moderate exercise after a bilateral pulmonary embolism?
Generally, the approach is to have the patient start their exercise regimen at a lower intensity and gradually increase it based on their tolerance.
How do you work up patients with low level monoclonal lymphocytosis and adenopathy?
Asymptomatic patients who have MBL (<5 x 10⁹/L malignant B-cells in blood) and associated lymph node disease that is palpable have the diagnosis of CLL/SLL. If they are asymptomatic, I do not scan these individuals or biopsy the palpable lymph node. My approach here would be to: Initiate prognostic...
What is your approach to screening for malignancy in dermatomyositis patients who do not have a high risk antibody profile and whose disease responds well to treatment?
This is a great question and one that is very relevant to our clinical practice. Different myositis specific and associated antibodies seem to carry different risks in their associations with cancer. My colleague, Dr. Alexander Oldroyd, has written our current guidelines on cancer screening for pati...
Would you continue or stop anticoagulation for a DVT/PE in a patient with active cancer who has completed 6 months of therapy?
This is an important question that we didn’t really have a clear answer for… until this year when an NEJM RCT was published! Mahé et al., PMID 40162636 In this RCT, patients with cancer-associated VTE who completed 6 months of full-dose apixaban were randomized to half-dose apixaban vs. full-dos...
How should elevated PT of unclear etiology and significance be evaluated?
Mild prolongation of the prothrombin time (PT) may represent a normal ‘outlier’. If there is no obvious explanation for a moderate to marked prolongation of the PT (for example, anticoagulation therapy effect, liver disease, nutritional deficiency like vitamin K deficiency. then the next step is to ...
In patients with essential thrombocythemia (ET) receiving hydroxyurea for cytoreduction who develop anemia — whether hydroxyurea-induced or from a concurrent etiology such as CKD — would you use ESAs?
This is an important question. Patients with ET should not have anemia related to the ET itself. Thus, assessing the etiology of the anemia is very important. If the anemia is from hydroxyurea, the first step is to lower the dose of the hydroxyurea. Controlling platelets should not come at the expen...
What are your top takeaways in Hematologic Malignancies from ASH 2025?
The PARADIGM study is a very important one that may result in a paradigm change for the treatment of AML. The study showed that outcomes are equal or better with AZA + VEN among patients with AML suitable for intensive chemotherapy. The efficacy was superior in response rate and EFS (but not overall...
What are your top takeaways in Lymphoma from ASH 2025?
Fixed-duration versus continuous targeted treatment for previously untreated chronic lymphocytic leukemia: Results from the randomized CLL17 trial — This trial may change practice by using the combination of BTK-I and Ven without CD20 antibodies. This time-limited option led to MRD, and I would expe...
What is your approach to iron supplementation in patients with an active infection?
In patients with active infections, I generally avoid intravenous iron due to the potential for promoting pathogen growth, a practice supported by cautions from nephrology and gastroenterology society guidelines. However, evidence for the risk of infection with IV iron is inconsistent, underpowered,...