Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How do you choose between TPO-RA for ITP?
Unfortunately, the initial choice of TPO-RA is often dictated not by patient or provider preference but rather by what insurance companies will cover. In an ideal world, the choice is determined in discussion with the family about whether they prefer an oral medication or subcutaneous injection, and...
What diagnostic workup is recommended when immune thrombocytopenia is present in multiple family members?
Genetic testing and confirmation that this is indeed immune thrombocytopenia and not a familial thrombocytopenia syndrome.
What is your preferred 1L treatment for newly diagnosed Del(17p)/TP53 mutation, high-risk CLL?
For patients with TN-CLL with TP53 aberration, the treatment options are usually based on patient factors. If a patient is a candidate for combination therapy, I prefer to treat them with uMRD-guided BTKi+BCL2i ± CD20 mAb. I only add a CD20 mAb to patients with no history of frequent infections and ...
How do you determine the optimal duration for 1L doublet treatment in newly diagnosed High-Risk CLL?
Among patients with high-risk CLL and indications for treatment per iwCLL criteria (Hallek et al., PMID 29540348), treatment regimens can be broadly categorized into fixed-duration, MRD-guided, and indefinite therapies. Fixed-duration doublet regimens include acalabrutinib with venetoclax per the AM...
Where do you anticipate positioning Mim8 (denecimig) alongside existing options within your hemophilia A prophylaxis approach, assuming regulatory approval (FRONTIER2)?
It is hard to say at this point, but I suspect it will be similar to emicizumab - i.e., it will be more frequently than the currently available rebalancing agents. What remains to be seen is if it will replace emicizumab by way of better perceived efficacy or only if someone is deemed to have "faile...
What is your approach to screening a cancer survivor for iron overload, and what is your treatment of choice?
We check the ferritin level after completion of chemotherapy. If ferritin is >1,000 ng/ml, we recheck the level as it can be falsely elevated with inflammation/infection. If ferritin is >1,000, we obtain a liver MRI with iron quantification. If liver iron concentration (LIC) is > 5 mg/g dry weight, ...
Are there still clinical situations in which you deliberately treat patients with a DOAC besides apixaban?
Thank you for your question. Apixaban has been my preferred agent for a long time for patients requiring therapeutic anticoagulation. Apixaban’s lower bleeding risk was shown prior to and now has additional evidence to support this with the COBRRA trial. The risk is also ameliorated by the safety in...
How do you choose among regimens for relapsed refractory myeloma?
To be brief - no one chooses elotuzumab with no single agent activity if Daratumumab is available, with its approximate 30% response rate in its pivotal study. I was just sitting down at a meeting with a number of myeloma physicians asking how do we currently choose treatment for relapsed myeloma.Fo...
What objective tools do you use to help determine if a patient is too high risk for anticoagulation to prevent stroke or DVT?
There are a number of risk scores, like HAS-BLED, that can be used, but I continue to use clinical judgment and shared decision-making. The excellent risk profile of NOACs and the availability of LAAO mean that I can usually come up with a solution for almost every patient that will protect them fro...
How to approach reversal of TNK in hemorrhagic conversion of ischemic stroke?
There is no specific "reversal agent" for tenecteplase. Once administered, the thrombolytic effect will persist until the drug is fully metabolized and any residual plasmin has been cleared by alpha-2-antiplasmin. So, perhaps the first question is what can you do if there is an acute bleeding event ...