Pediatric Hematology/Oncology   

Do you consider supportive transfusions, and if so, have you been successful with keeping patients on hospice while receiving transfusions? Do you us...

Labs with normal PT, but prolonged PTT (47 sec, ULN 40 sec) that does not correct on immediate mix. Lupus anticoagulant negative (DRVVT and hexagonal ...

How often does this occur and does this lower your suspicion for a "true" or clinically significant lupus anticoagulant?

Presuming good medication adherence.

vWF and FVIII activities ~200% and were checked because of the patient's family history of "coagulopathy". Is there any utility in repeating the test...

Do you consider starting Ursodiol? Do you perform routine abdominal ultrasound to monitor for cholelithiasis?

Chemotherapy is associated with acquiring C diff colitis. Does immunotherapy share that same risk and necessitate ruling out infection prior to anti-d...

Would you consider chronic RBC exchange versus HU?

Are there specific guidelines for managing this patient population?

Do you do additional workup for venous obstruction or any other different testing/evaluation?

Do social or economic factors (i.e., relative cost of acquiring LMWH, the patient being injection averse) affect your decision to use DOACs? Do you s...

Does this hold true when the patient has significant inflammation? 

Is there utility when classic inflammatory markers (ESR,CRP) or disease specific markers (C3, C4, dsDNA) do not correlate with patients disease activi...

I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...

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?

Ferritin >2200, TSAT >80%

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

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?  

How should IVIG and either biologic injections or infusions be spaced?

If so, for how long? 

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. 

What workup do you typically recommend?

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)?

Would a negative NGS eliminate the possibility of MDS? Is bone marrow biopsy indicated in a patient with pancytopenia with a negative NGS panel?

What else would you consider in your differential?

Is this an artifact of what agent prior clinical trials used or something to do with the mechanism of action (i.e., less mineralocorticoid effect of d...

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...

How do you "have the talk" in a way that is straightforward without emotionally crushing the patient?

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...

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

What are indications to order gene mutation studies (e.g. ELANE) and how would it help the patient?

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...

Is thrombotic risk too significant? Patient failed OCPs.

For example, if TSAT is less than 20% but ferritin is over 200. 

For instance, evaluation by primary care and GI without other etiology for splenomegaly

Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?

ALC<200

CRP 39 mg/L (normal < 10) and normal ESR

Presuming strong indication for ASA - eg history of NSTEMI

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

(e.g. beta 2 glycoprotein IgM > 20 but <40)

In patients who continue to have insomnia despite diphenhydramine, benzos, and trazodone, are there other evidence based treatments that are helpful?

e.g. K, Fya, s, etc

What is the impact among patients and providers? Has your documentation been adjusted now that patients can readily review?

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

IVIG, TPO, or other agents?

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

Are there other supportive care interventions that would otherwise be covered by hospice?

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

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

Is there a role for empiric antibiotics if there is history of opportunistic infection?

Would you consider this type of patient as having polycythemia?

What is the potential differential diagnoses for low iron saturation?

Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?

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

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

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

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

What if this was "triple-negative" antiphospholipid syndrome?

E.g. a patient with progression of their primary cancer but still is testing COVID19+ over a month after infection?

Are you placing more weight on patient risk factors such as age >65 or co-morbidities?