Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Is it appropriate to substitute vincristine for vinblastine in ABVD for systemic therapy of Hodgkins lymphoma?
I would give vinorelbine.
What is the ideal period to wait until curative surgery for patients with acute pulmonary embolism and solid malignancy?
This is a very important and practical question. As with most clinical circumstances, there is no evidence-based recommendation. The approach will vary with individual situations. For example: 1) Incidentally discovered subsegmental PE: my bias would be to proceed with curative surgery after one mon...
What is your preferred formulation of parenteral iron?
The question is not simple. The formulation I use the most is ferumoxytol because four insurance carriers allow a total dose infusion of 1020 mg in 20-30 minutes. This has been published twice (Auerbach et al., PMID 21922526 and Karki and Auerbach, PMID 31155744). Otherwise, it must be given as two ...
In a patient with amyloidosis and abnormal liver function but child Pugh A, would you still proceed with SABR for a liver metastasis?
No great data regarding the impact of amyloidosis on liver tolerance, but if the patient was a CP Class A patient, I would feel comfortable offering SABR for a liver metastasis.
How would you manage anticoagulation in a patient with acute MI or PE with prolonged aPTT due to congenital factor XII deficiency?
You can monitor anti Xa levels.
Would an MPL variant mutation of unknown clinical significance be considered diagnostic of essential thrombocytosis in a patient with longstanding elevation in the platelet count, and for whom all secondary causes have been excluded?
A bone marrow biopsy should be performed if not already done to complete diagnostic work-up for an MPN. If the MPL variant is truly of unknown significance, then that alone is not diagnostic of an MPN. The WHO 5th edition criteria for ET diagnosis are summarized in Loghavi et al., PMID 38043791 and ...
What is your perioperative approach to holding and restarting hydroxyurea in patients with essential thrombocythemia?
I would like to rephrase the question since as written, the assumption is that hydroxyurea is a preferred therapy for ET, when any careful reading of the literature will show that there is no proven rationale for using chemotherapy of any sort routinely in ET. There is no association between the pla...
When do you re-image patients with a diagnosis of venous sinus thrombosis?
My practice is to perform early reimaging, typically at around 2 weeks, before transitioning from parenteral anticoagulation to oral anticoagulation. This early reassessment is important as recanalization processes begin early and are linked to clinical outcomes. Subsequent imaging at 6 months is al...
How do you manage thrombocytopenia when radiating the spleen?
Radiation oncologists are occasionally asked to see patients with symptomatic splenomegaly (early satiety, dyspnea, and pain) and evaluate for radiation therapy. Many such patients have non-functional bone marrow from diseases such as primary myelofibrosis. This leads to extramedullary hemoatopoiesi...
How is transferrin saturation a reliable indicator for any parameter if serum iron is not reliable?
The question is a very good question. The Fe/TIBC must be drawn on an overnight fast including any vitamin pills containing iron. Otherwise, the serum iron is speciously elevated which in turn speciously elevates the TSAT. If those conditions are met, the TSAT is as good as the transferrin receptor ...