Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How do you approach making an acute pain IV opioid plan for a new adult SCD patient who doesn’t remember what has worked for them in the past?
I create an FYI at the initial clinic visit and go over the FYI with them so that we are both comfortable with the plan and the patient knows their plan. The first thing I would do is look through outside records, for example, if they are available in Care Everywhere. If that is not available, then ...
Would you continue or stop anticoagulation for a DVT/PE in a patient with active cancer who has completed 6 months of therapy?
This is an important question that we didn’t really have a clear answer for… until this year when an NEJM RCT was published! Mahé et al., PMID 40162636 In this RCT, patients with cancer-associated VTE who completed 6 months of full-dose apixaban were randomized to half-dose apixaban vs. full-dos...
How would you approach mantle cell lymphoma in very elderly patients?
For patients who are very elderly, my approach depends on the patient's performance status, other comorbidities, disease features/disease behavior, and indications for treatment. There are patients with MCL who can be observed at diagnosis (those with leukemic non-nodal disease but also those with l...
Would you advise mobility restrictions in a patient with Protein S deficiency and acute upper extremity DVTs but contraindications to anticoagulation (e.g., acute GI bleed) to reduce the risk of thrombus embolization?
This question is an interesting one and an incredibly specific scenario. I'll try to broaden the answer to cover a few more scenarios. So, the question gets at three elements: 1) Patient has an acute VTE, 2) Patient has a hypercoagulable state, 3) Patient has a contraindication to anticoagulation. S...
Do you screen children with sickle cell disease for silent cerebral infarcts?
We screen children with sickle cell disease for SCIs at our center. This is because data suggest that silent cerebral infarcts (SCIs) are much more common than overt stroke and the long-term negative impacts of SCIs are significant. There are also treatments (e.g., chronic transfusion and stem cell ...
What is your approach to IV fluid resuscitation during a sickle cell vaso-occlusive crisis?
My approach to IV fluid resuscitation in vaso-occlusive crisis is cautious and individualized. Adequate hydration is important to prevent further sickling, but I avoid aggressive fluid loading because of the risks of pulmonary edema and acute chest syndrome. I typically use isotonic balanced crystal...
Do you offer enasidenib with azacitadine in AML with an IDH2 mutation for patients ineligible for intensive induction chemotherapy?
I typically do not give enasidenib with azacitidine upfront for patients with AML with IDH2 mutation and ineligible for intensive induction chemotherapy. Based on the results of the VIALE-A study (DiNardo et al, NEJM 2020), I usually give venetoclax with azacitidine to those patients. In addition to...
Are there any alternative, hypofractionated RT courses for patients with DLBCL that can be used during the COVID-19 pandemic?
ILROG recently came out with guidelines pasted below: Synopsis of ILROG Recommendations for Administering Radiotherapy for Hematological Malignancies During Emergency Conditions of the COVID-19 Pandemic • We are facing an increased demand for RT to substitute or complement systemic therapy deemed i...
Do you defer bispecific antibody therapy in CAR-T-eligible patients with relapsed myeloma to keep CAR-T viable as a future option?
At this point in time, if I think that a patient is a good candidate for CAR-T therapy, I recommend that they pursue CAR-T prior to receiving a bispecific. Exceptions to this would be if there is a clinical trial available or if talquetamab is used as bridging therapy, but I would not administer a b...
How do you approach management autoimmune lymphoproliferative syndrome (ALPS) complicated by HLH?
HLH may respond to Gamifant and Anakinra - monitor CXCL19 cytokine.