Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Is there an optimal bridging radiation dose for aggressive B-cell NHL undergoing CAR T-cell therapy?
The perfect radiation dose for a given patient probably depends on a number of patient and disease-specific factors including tumor biology and genetics, the anatomy of the tumor and adjacent organs at risk, and the radiation technique used. We do not have the ability to recommend such individualize...
How do you approach an ITP patient who responds very well to steroids but the response is short-lived?
Introduce second line therapy. Rituxan pr TPO-RA.
Is there a role for prophylactic tranexamic acid in patients with hematologic malignancy with chemotherapy-induced thrombocytopenia?
There was a recent presentation at the American Society of Hematology testing the use of tranexamic acid in patients with thrombocytopenia in this situation. It did not show benefit. However, we use tranexamic acid if patients have platelet associated bleeding either qualitative or quantitative, and...
How do you manage significant asymptomatic indirect hyperbilirubinemia in patients with hemolytic diseases (SCD, HS, etc.)?
Hello, Indirect bilirubin is from hemolysis, not cholestasis (a few exceptions from rare syndromes), so not associated with stones, and would not expect ursodiol to help. It's a marker of how bad the sickling is - along with LDH, reticulocyte count, and MCHC (which measures cell density, i.e., irrev...
How do you manage occlusive bilateral retinal vasculitis with isolated lupus anticoagulant positivity?
Although I consider myself an expert on retinal vasculitis, I would often solicit help from a physician with expertise in coagulation, especially if that expertise is related specifically to the lupus anticoagulant. A tremendous part of the treatment strategy depends on the location and severity of ...
What are the treatment options for relapsed T-ALL in a patient who was nonadherent with AALL and hyper-CVAD regimens?
Regimens to consider with data for R/R T-ALL include: Nelarabine +/- chemotherapy. There are retrospective data to support adding nelarabine to a chemo backbone (Shimony et al., PMID 36508268 and Shimony et al., PMID 37389830). HMA + venetoclax (Pinton et al., PMID 37889114 and Cao et al., Blood 202...
How quickly do you expect iron stores to decrease after starting iron chelators?
This is a complex answer to what seems like a simple question. It is not a standard rate of decline because each patient's situation is different. It is always about the balance of how much iron is going in vs. how much iron is being excreted. Essentially there are 4 variables that must be considere...
How would you approach secondary stroke prevention in an adult with Hemoglobin SC disease?
Stroke is less common in HbSC disease than it is in HbS homozygotes (Ohene-Frempong et al., PMID 9414296). Thus, there are no studies focused on primary or secondary stroke prevention in HbSC disease. Recent guidelines for stroke management were “silent” on stroke in HbSC disease (DeBaun et al., PMI...
How do you decide between systemic antiangiogenic therapies for HHT?
Pomalidomide was just recently published in NEJM (Al-Samkari et al., PMID 39292928) showing efficacy in improving epistaxis in patients with HHT. It has an advantage as it is an oral agent versus bevacizumab being an IV infusion. Bevacizumab, however, has previously shown efficacy in smaller studies...
In what situations would you consider ESAs in hospitalized patients with severe anemia for indications other than CKD or myelosuppressive chemotherapy (e.g., ACD, hemorrhage)?
In deciding on the risk-benefit of ESAs in patients with severe anemia due to bleeding and/or inflammatory disease, there are two considerations. The first is the severity of the anemia and consequently, the time to initial response. Using the standard dose of ESAs, it may take 8 to 12 weeks to achi...