Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Is there a correlation between spleen size and degree of thrombocytopenia?
In a normal individual, approximately 1/3 of total body platelets are sequestered in the spleen at any given time. As the size of the spleen increases, so too does the proportion of platelets in the spleen increase. This is due to the total volume of the spleen, not just longitudinal measurement. It...
Would you consider continuing or re-trialing hydroxyurea for sickle cell patients after development of a leg ulcer?
I do not think HU is the cause of leg ulcers, neither does ASJ. Habibi et al., Blood 2023 Most cases of ulcers are multifactorial and studies have also included patients with thrombocytosis (even myeloproliferative disorders!!). Low nitric oxide is part of the cause of leg ulcers in most cases. HU r...
How do you manage severe lenalidomide-associated drug rash in a transplant-eligible patient with multiple myeloma?
A rash with lenalidomide occurs in up to a third of patients exposed, and it's likely that dose corresponds directly with rash severity. While excellent desensitization protocols appear effective (PMID 31400463), most of us want to be able to deal with this with a phone call or text message that inc...
Is a very rapidly rising WBC count ever an indication for the upfront treatment of CLL?
This situation, fortunately, does not arise frequently in CLL. But, when it does occur, it is a vexing question. According to the recommendations and guidelines of iwCLL, in absolute terms, the answer (to this question which is worded very carefully) is "NO". But, in my view, there is room for some ...
How do you manage prophylactic antimicrobial medications in patients who undergo ATG/cyclosporine/eltrombopag induction for severe aplastic anemia?
Yes for prophylactic antibacterials after ATG/cyclosporine and eltrombopag treatment of AA. Antiviral with valtrex 500mg oral twice daily and PJP prophylaxis while on immunosuppression with cyclosporine.Antibacterial with levofloxacin and antifungal prophylaxis with posaconazole 300mg oral daily or ...
Do you generally reduce DOAC dosing for extended anticoagulation in patients with first unprovoked VTE?
I frequently recommend low-intensity DOAC therapy in this setting, but only after careful consideration of the patient's risk factors for recurrent VTE and bleeding, and after determining the patient's preference about treatment options following a discussion of the pros and cons of each option.
How do you determine duration of anticoagulation for an ovarian vein thrombosis following a provoking event?
This specific question has not been addressed in a clinical trial to my knowledge. If the patient is symptomatic, I would anticoagulate for 3 months in the absence of a contraindication, just as I would for most other provoked VTE events. One might consider a watch and wait approach without anticoag...
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 ...