Pediatric Hematology   

Questions discussed in this category

Does this hold true when the patient has significant inflammation? 

Patients sometimes ask for annual urinalysis and ultrasound to monitor, but it is unclear if this is indicated.

Is a BM biopsy a must when there is skin involvement? If tryptase level is mildly elevated but less than 20 would you recommend a BM biopsy?

The ASH 2020 guidelines have "recommended that adults with HbSS or HbSβ0 thalassemia be screened at least once for silent cerebral infarcts even ...

Is it different than early mobility that we always encourage?

The patient was recently diagnosed with pre-B ALL and is on day 10 of CALGB 10403. He is expectedly neutropenic as he received daunorubicin and vincri...

There are various formulations of intravenous iron; each with varying costs, test dose requirement, elemental dose, and number or time of infusions ne...

While follow up ultrasound is not usually recommended in provoked DVT, it often is done either for other reasons or by other physicians. Would this in...

Common thought is that FVIII may be used for differentiating coagulopathy in liver disease (normal to increased, from reduced clearance of VWF/FVIII) ...

I.e. platelet count <30. Would your management change if HIT were only suspected rather than confirmed?  

E.g. Normal F8, VWF activity ~50%, VWF antigen ~100%, ratio 0.5 sent in a patient with positive bleeding history Is there any clinical significance t...

Specifically, asymptomatic subsegmental PE diagnosed within a month from planned bilateral mastectomy for breast cancer. 

Provided that the platelet count is normal, do you usually consider this to be a potential erroneous result or do you pursue additional workup for RBC...

How often do you see non transfusion-dependent thalassemia and how do you approach the treatment?

Although TIBC is negative acute phase reactant, would it be a better indicator of iron deficiency (in combination with ferritin)?

Such as the case in which a patient is unresponsive to steroids, IVIG, TPO-agonist, rituximab, splenectomy, and even fostamitinib.

Would you consider low dose indefinite anticoagulation in any scenario? Any difference in approach between hematological malignancy and solid tum...

Would it change your management if the thrombus was symptomatic? Or if larger >3 cm?

For example, a patient with a bone marrow biopsy that shows normocellular bone marrow. Prior management with leflunomide and HCQ with neutropenia attr...

If hydroxyurea modifies the course of sickle cell disease by increasing fetal hemoglobin, is there any benefit to using it in patients with fetal hemo...

Would you give a trial of IST first or immediately refer for SCT if the patient has matched siblings?

What would you want community oncologists to know when following these patients? Are there any other special issues to follow especially in AYA?

If so, what platelet count threshold would you use? Would age impact your decision? Would you do a bone marrow to rule out primary MPD in adults if th...

What is the ideal approach for female adolescent athletes if they have complaints of fatigue and dizziness and are diagnosed with mild iron deficiency...

That is, extra copy of one of the alpha genes resulting in an atypical alpha thalassemia for the patient, and beta thalassemia heterozygous carrier fo...

Please comment on temperature recommendations and role of exchange transfusion. 

While L-glutamine has minimal side effects and would likely be added after hydrea, how do you decide between the use of voxelotor and crizanlizumab?

In the absence of concerning bleeding or thrombosis, family history of coagulopathy, current anticoagulant use, or malnutrition

What type, dosage, and duration of treatment do you use? How does your practice change when there is an inhibitor?

What would you recommend within the first year after ATG and thereafter if still maintained on cyclosporine?

Such as the scoring system described by Summers et al, "Comprehensive Genomic Profiling of High-Risk Pediatric Cancer Patients Has a Measurable Impact...

Increased genomic testing is likely to increase the frequency with which we encounter these mutations, which we might not otherwise have tested for. H...

Ferritin uptrending >1000, no additional lab abnormalities. HFE wildtype. Too young for age-appropriate cancer screening. Asymptomatic except fatig...

Do you plan to change your practice based on the data presented in this JCO paper by Summers et al?

Patient with high titer acquired FVIII inhibitor with no causative etiology.  Bleeding is well-controlled on emicizumab, but inhibitor has failed...

The patient has no personal history of VTE, but has positive family history of VTE.  Any prophylactic anticoagulation options? How would manage...

For instance, if clonal hematopoiesis of indeterminate potential (CHIP) suspected 

I.e., what constitutes well-controlled cancer, IBD, nephrotic syndrome, etc. What other diseases do you put in this category (obesity, autoimmune dise...

APLA syndrome, obesity, non compliance ruled out and prefers another oral anticoagulation. Is higher dose of rivaroxaban or apixaban an option?

Should we stop checking factor VIII levels as part of thrombosis workup?

How would the approach differ if the patient had a significant bleeding phenotype vs only minor bruising and mucosal bleeding?

Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?

FVL heterozygotes are often treated similarly to the general population. Aside from avoiding other VTE risk factors, are there situations where prophy...

Given the POLARIX study data presented at ASH 2021, will this replace R-CHOP as the standard of care therapy in your practice? If not, how will y...

Would you offer indefinite anticoagulation if the event is unprovoked and the patient has low bleeding risk? 

Also is there value in using voxelotor for the purpose of reducing hemolysis, and if so what parameters do you use to determine when to initiate voxel...

Is there a particular sequence you would adjust contributing antirejection or antimicrobial medications? Is the use of G-CSF appropriate and at what c...

Hydroxyurea is demonstrated to reduce complications and improve long-term outcomes in severe genotypes HbSS and sickle beta0 thalassemia. What clinica...

What if the patient is triple-positive or has continued seropositivity on repeat lab testing? What is the appropriate interval of monitoring and does ...

Provoked or unprovoked VTE: Do you use D-Dimer (or even repeat imaging to reassess residual clot) in any capacity to guide anticoagulation duration? E...

Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?

Would you get bone marrow biopsy periodically? Would your approach change based off specific age or platelet count?  

There are multiple difficulties that could be seen: steroids can precipitate a sickle cell crisis, vasculitis and sickle cell can produce similar clin...

Patient with ferritin level <1000 ng/mL and no evidence of end-organ damage

Does manipulation of blood products (leukoreduction, irradiated) affect your approach? There is growing evidence that routine premedication (at least ...

While this is a known risk factor for venous [Meijers et al NEJM 2000] and potentially arterial [Yang et al, Am J Clin Pathol 2006] thrombosis, it is ...

Such as patients who are frail, elderly, renally impaired? Would you consider sirolimus over cyclosporine or tacrolimus for safer nephrotoxicity prof...

For example, do we prefer one regimen over the other in patients with a bleeding history or who have relapsed after a lengthy remission?

Especially in a triple-positive patient with an acute ischemic stroke who may have urgency for anticoagulation with high bleeding risk and severe thro...

Has your medical practice taken any steps either in community outreach or within the clinic to show support for this medically vulnerable population, ...

Given the high cost of eculizumab, are there patient characteristics that inform which patients, if any, should be on indefinite therapy versus a time...

Such as a patient who cannot tolerate oral iron and has had a anaphylaxis to intravenous iron

For example, a patient with hypogonadism unless it matters which organ is involved. Are other markers of iron storage useful in guiding therapy?

For example, in a patient who is steroid-refractory, requiring regular transfusion, and has not had response to rituximab after several weeks.

In a patient with a medical or personal indication to induce oligomenorrhea/amenorrhea, how would you manage OCP therapy if a patient develops a VTE d...

If autoimmune neutropenia already suspected, is this test informative or unnecessary?

What is the lowest level you have seen with uncomplicated or complicated crises?

Do you go straight to TMPRSS2 genetic testing or what other lab testing (e.g. hepcidin) could be helpful?

Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?

Does your opinion change based on the specific underlying inherited thrombophilia? The original case was a central retinal artery occlusion in a patie...

How are you changing your parent/visitor policies?  Are you testing for COVID-19 in all febrile patients? Has COVID-19 changed the care settings...

The unfavorable risk factors for stage I-II Classic Hodgkin's Lymphoma differ depending on the cooperative group (GHSG, EORTC, NCCN), which criteria d...

Papers discussed in this category

Acta Paediatr., 2020 Mar 23

Br. J. Haematol., 2020 Apr 30


Blood, 2021 Apr 01

Blood, 2018 Jun 26

Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 2016-04

Blood, 2018 Jul 12

Ann. Intern. Med., 2019 Oct 15

Blood Transfus, 2018 Oct 24

J Thromb Haemost, 2018 May 08

The New England journal of medicine, 2017-02-02

Blood, 2009 Nov 10

American journal of hematology, 2011-10

The American journal of medicine, 2017-12

American journal of hematology, 2018-05

Am J Hematol, 2020 Jun 29

Am J Hematol, 2019 Sep

Am J Hematol, 2019 Sep

Am J Hematol, 2018 Jun


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Blood, 2015 Dec 22

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BMJ, 2008 May 20


Journal of thrombosis and haemostasis : JTH, 2018-06-07

American journal of hematology, 2008-08

Blood, 2010-07-22

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Blood, 2017-07-20

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Blood, 2020 Dec 03

Rheumatol Int, 2019 Apr 30

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JAMA Netw Open, 2020 May 01

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Blood, 2013 Sep 19

The Lancet. Haematology, 2015-09

Haematologica, 2017-07

Thrombosis, 2013

Thrombosis journal, 2023 Oct 26

American journal of hematology, 2023 May 12

The New England journal of medicine, 2014 Aug 21

Haematologica, 2019 Oct 17

J Thromb Haemost,

Seminars in hematology, 2013-07

Haemophilia, 2020 Aug 3

Blood, 2012 Mar 12

Ann Oncol, 2021 Mar 18

Semin Hematol,

Blood, 2016-07-14

Blood, 2016 Sep 26

Transfusion, 2020 Sep 24

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Blood Adv,

Blood, 2019-06-06

Eur J Haematol, 2021 Feb 17

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Br J Haematol, 2013 Aug 02

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Am J Hematol, 2012 May 28

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JAMA, 2023 Aug 8

Blood, 2017 Jan 31

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The New England journal of medicine, 2008-03-27

The New England journal of medicine, 2020 Jun 25

Frontiers in genetics, 2022 Aug 26

Blood, 2024 Mar 21