Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What dose do you use to palliate multiple myeloma in a vertebral body?
For ISS Stage 1 MM patients who are going to have an OS of over 10 years, I generally prefer a more protracted regimen of 25 Gy in 10 fractions for improved durability of pain control. I typically only treat the symptomatic VB only and use inverse planning. If there is gross epidural disease or cord...
Would you consider using DOACs as a bridge to warfarin instead of heparin or LMWH?
I would feel very comfortable bridging with apixaban, given its relatively short half-life and fairly quick absorption. I think it is very similar to bridging with Lovenox. More importantly, it usually takes at least 24 hours until heparin IV gets to therapeutic levels - it is often too high or too ...
Does plasma donation cause iron deficiency?
It really shouldn't but small amounts of blood are lost with the pheresis machine so it may occur with frequent donation. I would make sure to check from time to time. There are only marginal amounts of Fe in plasma so infrequent donations are unlike to cause iron deficiency.
How would you treat severe, symptomatic splenomegaly in a patient with ET/MF who has progressed through all approved JAK inhibitors and is not a candidate for alloSCT?
Refractory symptomatic splenomegaly to JAK inhibition is thankfully not common but does occur and requires consideration of both pharmacologic and non-pharmacologic strategies.Clinical trials should first be explored but if none are available or the patient is ineligible, then you can consider hypom...
How would you counsel a female to male transgender patient regarding VTE risk with testosterone therapy, who has additional mild-moderate risk factors for thrombosis?
If physiologic concentrations of testosterone are not exceeded and the hematocrit is monitored to avoid a pathologic level of erythrocytosis, the risk for thrombosis from testosterone GAHT does not appear to in excess of the general population. I would refer you to the following two articles that pr...
What is your approach to symptomatic superficial thrombosis of the pelvic veins occurring in the immediate postpartum period?
I would strongly consider anticoagulation in this scenario given the high risk of thrombosis in the postpartum period.Generally, there is a low threshold to place patients on prophylactic dose anticoagulation for six weeks postpartum (personal history of thrombosis, inherited thrombophilia) given th...
Would you recommend anticoagulation in subsequent pregnancies after symptomatic postpartum R ovarian vein thrombosis?
The 2018 ASH guidelines recommend the following: For women not already receiving long-term anticoagulant therapy who have a history of VTE, the panel makes the following recommendations: Unprovoked VTE (strong recommendation, low certainty): and provoked VTE, hormonal risk factor (strong recommendat...
Would you continue venetoclax indefinitely/until disease progression in patients treated with upfront venetoclax for TP53 mutated CLL?
First of all, for the del(17)(p13.1) and/or TP53 mutated CLL patients, venetoclax + obintuzumab may not be the best option based upon data from the CLL14 trial showing early PFS in this group as compared to what has been demonstrated in both up-front ibrutinib and acalabrutinib studies. However, we ...
How does your approach to subsegmental PE differ from segmental PE both diagnostically and therapeutically?
My approach to subsegmental PE and segmental PE generally tends to be very similar. I am aware of the CHEST guidelines which indicate patients can safely be observed with subsegmental PE, but like a recent study showed (Rouleau et al., PMID 37531107), uptake of these guidelines is slow and many pati...