Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
In pediatric patients with newly diagnosed B-cell ALL and underlying Lynch syndrome, how does the MMR deficiency inform your treatment planning and survivorship surveillance?
Treat B-cell ALL with chemotherapy appropriate for risk category and usual follow-up. MRI Brain Q 6 months up to age 20, then annually Colonoscopy annually starting at age 6 years Upper endoscopy at age 10 years and annually Whole body low dose MRI annually Physical examination and skin exam every ...
How do you approach chemotherapy-induced thrombocytopenia in patients who do not respond adequately to romiplostim?
That's definitely a difficult and highly nuanced clinical scenario, especially since it can hamper future delivery of chemotherapy and compromise disease outcomes. My approach to this question also depends on whether we are talking about patients with a hematologic or solid tumor malignancy. I will ...
How is the CARES kappa subgroup data changing your approach to newly diagnosed kappa AL amyloidosis?
These results are the first to demonstrate the potential impact of an anti-fibril therapy and are clearly an exciting advance for the field. However, clinical use of this approach is dependent on regulatory approval and further clarification of the results regarding its applicability outside of the ...
What is your preferred management strategy for a patient with hairy cell leukemia requiring treatment who has stage 3 CKD?
This is an excellent question and depends on factors beyond just renal function. I do not have one preferred regimen for patients with hairy cell leukemia with impaired renal function (or without). Treatment selection depends on the disease features, prior treatments received, patient comorbidities ...
With talquetamab-based combinations Tal-DP and Tal-D now showing efficacy at first relapse, if approved, how will you position GPRC5D-targeted bispecifics relative to BCMA-directed therapy in your treatment algorithm for relapsed/refractory MM after 1 prior line of therapy?
TL;DR: The choice between BCMA and GPRC5D will likely depend less on the efficacy data and more on prior BCMA exposure and toxicity profiles.The phase 3 MonumenTAL-3 trial randomized patients with first or early relapsed multiple myeloma to talquetamab/daratumumab/pomalidomide (Tal-DP), talquetamab/...
How would you approach iron supplementation in a beta thalassemia trait patient with restless leg syndrome?
Thalassemia does not alter my decision. I don't use PO iron for RLS as it is enormously more toxic. A ferritin of 75 is a light-year away from iron overload, and a total dose infusion of IV iron can be administered with impunity. This patient should be treated with a gram of LMW iron dextran over on...
What is the optimal antithrombotic management, if at all, in patients with incidentally identified findings of multiple silent embolic appearing cerebral infarcts?
It is important to confirm the pattern is embolic. If unsure, input from a specialized physician (such as vascular neurology or neuro-radiology, if available) can aid in confirming the diagnosis. Various white matter findings may mimic an embolic pattern, and distinguishing between unilateral...
When do you pursue additional workup for incidental thrombocytosis in hospitalized patients?
Since most acutely ill patients will have lab evidence of acute illness, including thrombocytosis, I usually do not work it up during the hospital stay. But it should be stated in the discharge summary and followed up post-discharge.
Do you recommend vitamin C supplementation with PO iron in patients with iron deficiency?
Vitamin C supplementation is unnecessary. Taking the iron with a glass of orange juice away from food and especially coffee optimizes absorption. That being said vitamin C does no harm. See vonSiebenthal et al eClinical Works 2023 (Lancet publication), Benson et al, Lancet Haem 2025 or Auerbach et a...
How do you manage patients with embolic stroke of an undetermined source and a papillary fibroelastoma found on an echocardiogram?
The definitive treatment is surgical, and the only way of knowing for certain that the lesion is a fibroelastoma is to perform surgery and obtain pathology. If a patient is not a candidate for heart surgery, anticoagulation could be tried.