Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How do you decide between HSCT and immunosuppressive therapy for treating hepatitis associated aplastic anemia?
For young people with a donor, the primary therapy is transplantation. It is curative in the vast majority of patients, hepatitis-associated AA is much less likely to respond to immunotherapy.
How would you approach post-operative VTE prophylaxis for renal transplant in patients with a prior history of provoked VTE?
I am not aware of published systematic reviews, risk models, or evidence-based guidelines for post-operative prophylaxis in renal transplant patients. Given both increased risk for VTE and bleeding, it is not surprising that there is a large variation in practice (for relatively recent survey on t...
For patients diagnosed with T-cell lymphoblastic lymphoma with CNS involvement (CSF), what is your approach to the typical schedule for IT chemotherapy?
In general, the schedule of IT chemotherapy is dictated by the systemic chemotherapy regimen chosen. For example, with a pediatric-inspired regimen like C10403, those with CNS involvement receive more LPs during the Remission Induction course. For hyperCVAD, the historical approach has been to give ...
How do you manage a DOAC if interested in testing for lupus anticoagulant?
Testing for anti-phospholipid antibodies encompasses two broad categories of testing. One is an ELISA based (aka solid phase) set of tests that include anti-cardiolipin and anti-beta 2 glycoprotein I antibodies. ELISA assay are not affected by DOACs. For the second lupus anticoagulant (aka fluid pha...
How would you treat a patient with Hodgkin lymphoma who has an isolated relapse within the CNS?
It's challenging to offer specific advice in this situation without knowing a lot more. First, it's important to recognize that CNS involvement by classical Hodgkin lymphoma is extremely rare and strictly requires a brain biopsy to make a diagnosis (even in a patient with active systemic CHL, a seco...
What are the indications for anticoagulation in splenic infarctions?
A great reminder that splenic infarct relates to ARTERIAL thromboembolism and not to VENOUS VTE. Too often, I see massive, blind thrombophilia work-up for (incidentally) detected splenic infarcts.
How do you approach evaluation for underlying rheumatologic disease in patients with chronic asymptomatic thrombocytopenia?
APL testing as well as evaluation for SLE and Sjogrens with complement, urine, antibody testing, not just an ANA.
Would you treat with AZA + venetoclax to achieve CR2 before proceeding to allogeneic stem cell transplant in a young, fit patient with favorable risk AML who relapsed within a year after 7+3 and HIDAC consolidation?
It would be important to know what type of "favorable risk" AML the patients had and also what the current NGS shows. I would wait on NGS results to return to see what the options are first in targeted therapies a potential option. If the patient had Core Binding Factor (CBF) AML, a high dose cytara...
For hypogammaglobulinemia as a complication of successful treatment, do you empirically start prophylaxis with either 400 mg/kg monthly for IVIG or 100 mg/kg weekly for subcutaneous immune globulin?
Most of the data to support IVIG for hypogam comes from CLL literature. Data in those post-transplant and post-CAR T are limited. IVIG has a reputation of being a bit of a panacea, but I challenge that notion. We investigated the implementation of an IVIG stewardship plan to limit IVIG usage just fo...
How do you decide between using ropeginterferon alfa-2b and peginterferon alfa-2a in MPN?
In general, I favor ropeginterferon as it is FDA-approved and allows for less frequent, every 2-week dosing as compared to peginterferon which is used off-label and requires weekly dosing. However, ropeginterferon is not currently approved for ET and in patients where I decide to use interferon in t...