Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What experience have you had with familial clustering of polycythemia vera?
JAK2 V617F is a somatic mutation that can be acquired as early as in utero based on elegant work by Williams et al., PMID 35058638.There is some data available regarding familial MPN predisposition syndromes and this review very nicely summarizes much of the available data (Lim et al., PMID 39316992...
Do you have a preferred IV iron formulation for pregnant women?
I prefer INFeD, Feraheme, Monoferric, and FCM is okay. INFeD, Feraheme, and Monoferric are also preferred in non-pregnant patients. FCM in non-pregnant patients has a risk of hypophosphatemia, but for some reason, FCM (InjectaFer) does not cause hypophosphatemia in pregnancy, likely due to renal ada...
How do you dose apixaban in patients with CrCl <30 mL/minute?
Patients with chronic kidney disease are challenging to treat with anticoagulation as they have an increased risk of both venous thromboembolism and bleeding. Treatment should be individualized after weighing the risks and benefits of anticoagulation as well as the indication for anticoagulation. Th...
How do you manage a patient with JAK2+ ET without history of thrombosis during pregnancy?
Great question. We've recently published our experience here How et al., PMID 33022566. Patients with ET that are pregnant and that don't have a history of thrombosis are likely to be in the very low/low risk categories by R-IPSET, many of these women are likely not on any treatment prior to startin...
What radiation treatment volume and dose would you deliver to an isolated DLBCL relapse in the left eye s/p vitrectomy and intraocular methotrexate?
This is a case of secondary ocular lymphoma but the management of primary ocular lymphoma may be helpful to consider. For patients with primary ocular lymphoma, a significant number of patients present with bilateral disease at initial diagnosis or will relapse in the contralateral eye after unilate...
Is prophylactic anticoagulation indicated in patients with frequent ulcerative colitis flares?
Background: We know that inflammatory bowel disease (IBD) is a risk for incident and recurrent venous thromboembolism (VTE). What is not clearly established is whether the IBD needs to be 'active' in order for it to be a risk factor, e.g. would patients who have had proctocolectomy (and perhaps no e...
Would you change an elderly, frail patient with atrial fibrillation who is already on a NOAC to VKA treatment?
I wouldn't on the basis of this study. Aside from the other limitations of the FRAIL-AF trial, this study only addressed the utility of switching a stable patient from VKA to NOAC and not vice versa. A patient who is doing well on an appropriately dosed NOAC may experience difficulty achieving adequ...
Should platelet transfusions be considered for anti-platelet agent reversal in patients with major bleeding?
Patients on plavix and/or aspirin are at risk for bleeding whether in relation to surgery or bleeding from the gi tract. Much like the management of patients on anticoagulation temporary reversal of antiplatelet drugs is only achieved by normalizing platelet function. This is the same principle used...
How do you manage concurrent non-life-threatening hemoptysis and acute pulmonary embolism?
Hemoptysis can occur with PE when there is pulmonary infarction. However, the majority of pulm embolism cases have pleuritic chest pain without infarction. Significant hemoptysis is very rare in these cases and anticoagulation is nearly always safe. When hemoptysis continues or the volume is concern...
What is your protocol for transitioning to oral anticoagulation post-thrombolysis for pulmonary embolism?
My answer has multiple parts."Thrombolysis" is not all the same. As studied in stroke treatment, alteplase causes marked fibrinogen depletion and coagulopathy (prolonged PT, aPTT), whereas tenecteplase doesn't so much (Huang et al., PMID 26514192).So, if alteplase was used (systemic or reduced cathe...