theMednetRegister

Internal Medicine

Pediatric Hematology   

Questions discussed in this category

For von Willebrand type 2B, do you expect a decline in platelet count over time as vWF increases with age?
1 Answer available
Can anti-cardiolipin or anti-beta-2 glycoprotein antibodies cause prolonged PTT in the absence of a lupus anticoagulant?
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 ...
1 Answer available
Is there any benefit of using aspirin to mitigate VTE risk in testosterone-induced polycythemia?
2 Answers available
How do you approach the work-up for a patient with iron deficiency anemia who is not responding to oral iron therapy?
Presuming good medication adherence.
1 Answer available
How do you manage significant asymptomatic indirect hyperbilirubinemia in patients with hemolytic diseases (SCD, HS, etc.)?
Do you consider starting Ursodiol? Do you perform routine abdominal ultrasound to monitor for cholelithiasis?
1 Answer available
When would you initiate exchange transfusion in babesiosis and significant hemolysis?
Is parasitemia >10% and severe hemolysis with Hb less than 7 enough to initiate this?
1 Answer available
How do you counsel sickle cell patients on the use of G-CSF to treat neutropenia from other causes, like malignancy?
Do you discuss the risk of sickle cell crises with G-CSF? What about for patients with sickle cell trait?
1 Answer available
What would you recommend for long term management of extensive dural venous sinus thrombosis (CVST) in young females when the only provoking risk factor is combined OCP?
Thrombophilia testing, including JAK2 is negative. When would you stop anticoagulation?
3 Answers available
When would you consider using G-CSF in patients with rheumatic disease who have received cyclophosphamide?
2 Answers available
Is there any benefit to using desmopressin over vWF replacement therapy for vWD?
If not, has your practice changed to use vWF replacement therapy more routinely for perioperative or acute bleeding management? Do you still perform D...
1 Answer available
How would you approach secondary stroke prevention in an adult with Hemoglobin SC disease?
Would you consider chronic RBC exchange versus HU?
1 Answer available
How would you approach post-operative VTE prophylaxis for renal transplant in patients with a prior history of provoked VTE?
Are there specific guidelines for managing this patient population?
1 Answer available
How do you approach managing depression symptoms in patients who have had repeated high risk of bleeding?
When do you determine SSRI therapy is unsafe to pursue in such situations?
2 Answers available
Can a patient still have primary HLH even in the absence of any HLH associated genetic mutations?
rWGS did not demonstrate any HLH definable or associated mutations.
1 Answer available
Is there any indication for hydroxyurea in patients with sickle cell trait?
2 Answers available
What would your next line of treatment be for a patient with Hb SC with history of recurrent VOC and new bone infarct who is already on hydroxyurea and phlebotomy?
Hb at goal of 9-10
2 Answers available
How is your experience with point-of-care INR systems for home monitoring of vitamin K antagonists?
Are the INRs reliable? In what scenarios would you not recommend POC INR use for warfarin monitoring? Are these typically covered by insurance? Are t...
1 Answer available
How do you manage arthritis resulting from deferiprone in transfusion dependent thalassemia?
1 Answer available
Does your evaluation of a young person with spontaneous upper extremity DVT vary as compared to lower extremity DVT?
Do you do additional workup for venous obstruction or any other different testing/evaluation?
1 Answer available
How do you manage hemophilia A carriers with no history of bleeding complications but with mildly low factor VIII activity (6-40%)?
1 Answer available
What subset of sickle cell disease patients are you offering sickle cell disease gene therapy?
1 Answer available
How do you manage hyperalgesia in patients with sickle cell disease?
1 Answer available
Is it true that a ferritin above 200 essentially rules out iron deficiency?
Does this hold true when the patient has significant inflammation? 
1 Answer available
What parameters would you use to monitor and interpret iron levels in a hemochromatosis patient where ferritin is unreliable due to underlying chronic inflammation?
How would your recommendation change if the patient has H63 homozygous mutation?
2 Answers available
What is your strategy for optimizing hydroxyurea dosage in patients with symptomatic sickle cell disease, particularly for genotypes HbSS and HbS/Beta thal?
1 Answer available
What is your target Hgb/Hct for women who are pregnant and have sickle cell disease in whom you are doing scheduled transfusions?
2 Answers available
Do you screen children with sickle cell disease for silent cerebral infarcts?
1 Answer available
How would you manage a CVST secondary to a traumatic brain injury with the presence of intracranial hemorrhage?
When would you consider using anticoagulation and for how long?
4 Answers available
For patients with suspected complement-mediated TMA, are there specific clinical or laboratory parameters that can help guide the decision for starting empirical treatment (e.g., eculizumab) while awaiting the results of complement testing?
1 Answer available
When would you initiate chronic therapeutic phlebotomy in a patient with erythrocytosis secondary to a high hemoglobin-oxygen affinity hemoglobinopathy?
1 Answer available
How would you work up a patient with cutaneous mastocytosis?
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?
1 Answer available
Do you screen adults in your practice with sickle cell disease for silent cerebral infarcts?
The ASH 2020 guidelines have "recommended that adults with HbSS or HbSβ0 thalassemia be screened at least once for silent cerebral infarcts even ...
1 Answer available
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
1 Answer available
How do you monitor risk of erythrocytosis from testosterone use for female to male transgender patients?
1 Answer available
Are SCDs contraindicated in patients with acute DVTs?
Is it different than early mobility that we always encourage?
3 Answers available
For a patient with May-Thurner syndrome and DVT, would you recommend anticoagulation for 3-6 months or indefinitely?
4 Answers available
What is your practice regarding giving G-CSF to patients with ALL during initial induction?
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...
2 Answers available
How would you manage a young patient with HL who develops HF (EF < 30%) after 4 cycles of A+AVD who obtained a PET2 CR?
2 Answers available
How do you manage mild Type 1 von Willebrand disease undergoing wisdom teeth removal?
Antifibrinolytic therapy alone +/- DDAVP?
1 Answer available
What additional testing is recommended with heterozygous HFE C282Y mutation whose ferritin is elevated and transferrin saturation percentage is at baseline?
Ferritin >2200, TSAT >80%
2 Answers available
What is your preferred formulation of parenteral iron?
There are various formulations of intravenous iron; each with varying costs, test dose requirement, elemental dose, and number or time of infusions ne...
1 Answer available
Would you extend the duration of anticoagulation in patients with a provoked DVT, but evidence of residual clot at 3 months?
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...
3 Answers available
How do you approach an ITP patient who responds very well to steroids but the response is short-lived?
How would you counsel the patient if he/she wants to continue on steroids?
3 Answers available
Do you use FVIII levels to differentiate between DIC and coagulopathy of liver disease?
Common thought is that FVIII may be used for differentiating coagulopathy in liver disease (normal to increased, from reduced clearance of VWF/FVIII) ...
4 Answers available
How do you approach anticoagulation in the setting of HIT and thrombocytopenia?
I.e. platelet count <30. Would your management change if HIT were only suspected rather than confirmed?  
1 Answer available
How would you treat a woman with iron deficiency anemia, unresponsive to iron sulfate, and with allergic reaction to iron sucrose?
Anemia is secondary to menorrhagia. No gynecologic interventions were possible.
1 Answer available
Are there any possible scenarios where you would do phlebotomies for heterozygous hemochromatosis?
1 Answer available
How do you dose apixaban in patients with CrCl <30 mL/minute?
1 Answer available
Do you consider starting hydroxyurea in a patient with hemoglobin S-beta thalassemia with chronic kidney disease secondary to FSGS?
No transfusion dependence but has hemoglobin in the 8-9 g/dl range.
1 Answer available
What is your approach to using medications that can cause bone marrow suppression in SLE patients who have persistent leukopenia?
3 Answers available
Would you anticoagulate a patient with splenic infarctions in the setting of CMV viremia?
If so, for how long? 
1 Answer available
How do you interpret a low VWF activity/antigen ratio, when both activity and antigen levels are above 50%?
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...
1 Answer available
What is the ideal period to wait until curative surgery for patients with acute pulmonary embolism and solid malignancy?
Specifically, asymptomatic subsegmental PE diagnosed within a month from planned bilateral mastectomy for breast cancer. 
1 Answer available
How do you approach a persistently elevated mean platelet volume and immature platelet fraction in an otherwise healthy patient with a normal platelet count?
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...
1 Answer available
When should you use caplacizumab in the treatment of acute TTP patients?
1 Answer available
Is there a correlation between spleen size and degree of thrombocytopenia?
1 Answer available
How would you adjust the steroid dose for steroid-induced psychosis in a patient being treated for secondary HLH with the HLH-94 protocol?
1 Answer available
How would you approach microcytosis without anemia with high TSAT and ferritin?
How often do you see non transfusion-dependent thalassemia and how do you approach the treatment?
1 Answer available
How is transferrin saturation a reliable indicator for any parameter if serum iron is not reliable?
Although TIBC is negative acute phase reactant, would it be a better indicator of iron deficiency (in combination with ferritin)?
1 Answer available
Should testing for genetic causes of HLH be performed in all patients with MAS or secondary HLH regardless of the patient's age?
2 Answers available
What is your practice for work up and treatment of incidental splenic infarcts with or without splenomegaly in patients without sickle cell disease?
1 Answer available
For patients with microcytosis MCV 75-79 and normal Hb, low TIBC, and normal ferritin do you always rule out thalassemia?
What else would you consider in your differential?
5 Answers available
How do you approach very treatment-refractory ITP?
Such as the case in which a patient is unresponsive to steroids, IVIG, TPO-agonist, rituximab, splenectomy, and even fostamitinib.
1 Answer available
How do you approach dosing of anakinra in MAS?
1 Answer available
For patients with incidental findings of venous thromboembolism during workup of a treatable malignancy, how do you approach discontinuation after the treatment is complete?
Would you consider low dose indefinite anticoagulation in any scenario? Any difference in approach between hematological malignancy and solid tum...
1 Answer available
In a young female with severe osteoporosis due to congenital estrogen deficiency, can estrogen be prescribed if genetic testing for congenital disorders reveals a heterozygous Factor V Leiden mutation?
No prior thrombosis; no family history of thrombosis. As per endocrine, the only useful therapy for the osteoporosis is estrogen. 
1 Answer available
How do you approach diagnosis and treatment of HLH/MAS following CAR T-cell therapy?
How is this entity distinct from other secondary HLH entities? 
2 Answers available
What is your approach to treatment of infection-triggered HLH that does not respond to treatment of the underlying infection?
2 Answers available
In the setting of secondary HLH associated with initial diagnosis of lymphoma, would you adjust steroid dose and type to account for differences in HLH and lymphoma treatment protocols?
1 Answer available
When should I consider anticoagulation in an unprovoked upper extremity superficial venous thrombosis?
Would it change your management if the thrombus was symptomatic? Or if larger >3 cm?
1 Answer available
What are the best labs to trend improvement in HLH?
1 Answer available
What is your approach to further work-up and management of neutropenia in patients with SLE/RA overlap?
For example, a patient with a bone marrow biopsy that shows normocellular bone marrow. Prior management with leflunomide and HCQ with neutropenia attr...
2 Answers available
In a patient hospitalized for several days with a refractory pain crisis would you ever consider transfusion, either simple or possibly exchange in an attempt to get the patient over the crisis?
2 Answers available
Do you recommend hydroxyurea in patients with sickle cell disease with hereditary persistence of fetal hemoglobin who have recurrent vaso-occlusive crises requiring hospital admission?
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...
1 Answer available
When do you refer AYA patients with newly diagnosed severe aplastic anemia for transplant?
Would you give a trial of IST first or immediately refer for SCT if the patient has matched siblings?
2 Answers available
Would you use PCC for clotting factor repletion in acute life threatening hemorrhage in a patient with elevated INR from coagulopathy of liver disease?
2 Answers available
For T cell ALL treated in CR (without transplant), how often do you do BM biopsies as part of surveillance, and for how long?
What would you want community oncologists to know when following these patients? Are there any other special issues to follow especially in AYA?
1 Answer available
How do you approach a patient with chronic low ADAMTS13 activity and low level of inhibitor without signs of thrombocytopenia or hemolysis?
ADAMTS13 level <5% Inhibitor level <1
1 Answer available
How do you explain TTP to patients?
1 Answer available
When patients develop headaches from luspatercept, do they tend to improve over time?
1 Answer available
Would you consider TPO mimetics for chemotherapy induced thrombocytopenia that persists despite dose reductions?
1 Answer available
Do you repeat images in patients with venous thrombosis to inform decision about duration of anticoagulation?
E.g. pulmonary embolism, portal vein thrombosis, cerebral venous sinus thrombosis
2 Answers available
Do you recommend starting an antiplatelet for primary prophylaxis in post splenectomy thrombocytosis given there is some increased risk of venous thrombosis?
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...
1 Answer available
What is the optimal age at which a patient with sickle cell disease should undergo allogeneic stem cell transplant?
2 Answers available
What is your ferritin threshold to prescribe iron to female adolescent athletes who have symptomatic iron deficiency without anemia?
What is the ideal approach for female adolescent athletes if they have complaints of fatigue and dizziness and are diagnosed with mild iron deficiency...
1 Answer available
How do you perform fertility counseling for a patient with a duplication of one of the alpha genes and their partner who has a beta chain point mutation?
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...
1 Answer available
What precautions do you take prior to CABG in a patient with sickle cell trait?
Please comment on temperature recommendations and role of exchange transfusion. 
1 Answer available
In sickle cell patients with continued pain crises despite hydroxyurea, how do we sequence the use of newer agents?
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?
3 Answers available
How do you approach low to moderate titer of APLS when working up unprovoked DVT if it is persistent on repeat testing?
4 Answers available
Would you consider using DOACs in a young patient with SLE and Libman-Sacks endocarditis, who is negative for APS?
2 Answers available
Do you screen for VWD in all women with menorrhagia severe enough to cause iron deficiency anemia?
3 Answers available
How should elevated PT of unclear etiology and significance be evaluated?
In the absence of concerning bleeding or thrombosis, family history of coagulopathy, current anticoagulant use, or malnutrition
2 Answers available
How would you approach a low to moderate titer of one of the APLS antibodies in a patient with a strong family history but no personal history of thrombosis?
Although testing was not indicated, what do u do with these results? Other hypercoagulability work up negative
2 Answers available
What are your top takeaways from ASH 2022?
8 Answers available
Is rituximab for refractory ITP contraindicated in the setting of an active COVID infection, particularly in a patient with asymptomatic COVID?
2 Answers available
Would you discontinue anticoagulation in patients with antiphospholipid antibody syndrome, who have a remote history of thrombotic events and are now negative for pathogenic antiphospholipid antibodies?
Would the answer differ if the index event was arterial vs venous? 
3 Answers available
How do you advise patients with sickle cell disease on contraception?
Do you advise against combination OCPs?
1 Answer available
Do you do prophylactic LP/IT chemotherapy in high risk APML prior to starting consolidation?
1 Answer available
How would you approach management of bleeding risk and factor VIII replacement in a patient with severe hemophilia A undergoing stem cell transplant?
1 Answer available
What is your perioperative approach for a patient with severe hemophilia?
What type, dosage, and duration of treatment do you use? How does your practice change when there is an inhibitor?
1 Answer available
How would you work up a mildly neutropenic patient (ANC >800) with family history of neutropenia and personal history of occasional mouth sore?
What are indications to order gene mutation studies (e.g. ELANE) and how would it help the patient?
1 Answer available
How do you manage prophylactic antimicrobial medications in patients who undergo ATG/cyclosporine/eltrombopag induction for severe aplastic anemia?
What would you recommend within the first year after ATG and thereafter if still maintained on cyclosporine?
1 Answer available
Which patients with acute promyelocytic leukemia do you consider maintenance after completing consolidation?
1 Answer available
How do you work up a young patient with increasing ferritin and normal TSAT without infectious, inflammatory, or liver disorders?
Ferritin uptrending >1000, no additional lab abnormalities. HFE wildtype. Too young for age-appropriate cancer screening. Asymptomatic except fatig...
1 Answer available
In a patient with Type I von Willebrand disease with history of VTE and heavy menses, would tranexamic acid be a treatment option?
Is thrombotic risk too significant? Patient failed OCPs.
3 Answers available
Do you stop hydroxyurea or switch to an alternative therapy in a male patient with controlled Hb SC disease who is interested in having children?
2 Answers available
At what ferritin threshold would a patient with anemia of inflammation or malignancy no longer benefit from iron supplementation for functional iron deficiency?
For example, if TSAT is less than 20% but ferritin is over 200. 
1 Answer available
Based on recent data would you consider adding ATRA to low dose rituximab for steroid refractory ITP?
Wu et al., PMID 34665865 
1 Answer available
When do you stop trying to eradicate an acquired factor VIII inhibitor?
Patient with high titer acquired FVIII inhibitor with no causative etiology.  Bleeding is well-controlled on emicizumab, but inhibitor has failed...
3 Answers available
What recommendations do you have for a transgender female patient with history of prothrombin gene mutation who is interested in starting gender affirming hormone therapy?
The patient has no personal history of VTE, but has positive family history of VTE.  Any prophylactic anticoagulation options? How would manage...
1 Answer available
Do you hold IV iron in the setting of active infection?
1 Answer available
Do you routinely send NGS testing from bone marrow samples in patients with unexplained cytopenia or cytoses?
For instance, if clonal hematopoiesis of indeterminate potential (CHIP) suspected 
1 Answer available
In patients with severe hemophilia A on emicizumab for prophylaxis, in case of noncompliance leading to a lapse of more than 2-3 months off therapy, do you reload with emicizumab?
1 Answer available
In patients who develop a VTE, what conditions do you consider as persistent, provoking risk factors, and at what point are they controlled enough to stop anticoagulation?
I.e., what constitutes well-controlled cancer, IBD, nephrotic syndrome, etc. What other diseases do you put in this category (obesity, autoimmune dise...
1 Answer available
How soon do you anticipate response to cyclosporine in red cell aplasia and what cyclosporine trough levels do you target?
1 Answer available
How would you work up and manage persistent lymphopenia in an asymptomatic patient?
ALC<200
1 Answer available
Do you consider travel as a risk factor for DVTs in the absence of any other underlying predisposing factors?
i.e. long car rides or plane rides
1 Answer available
Is an elevated CRP an expected finding in an otherwise healthy patient with hemoglobin S - alpha thalassemia?
CRP 39 mg/L (normal < 10) and normal ESR
1 Answer available
How would you manage someone with antithrombin deficiency who has recurrent VTE on a DOAC?
APLA syndrome, obesity, non compliance ruled out and prefers another oral anticoagulation. Is higher dose of rivaroxaban or apixaban an option?
2 Answers available
Does normal methylmalonic acid levels absolutely rule out vitamin B12 deficiency?
1 Answer available
In a patient with sickle cell disease on hydroxyurea who is planning to have a family, for how long should they be off the drug before trying to conceive?
1 Answer available
How do you counsel patients with elevated factor VIII levels for their thrombosis risk?
Should we stop checking factor VIII levels as part of thrombosis workup?
1 Answer available
How do you interpret elevations in antiphospholipid antibodies that are lower than Sapporo criteria?
(e.g. beta 2 glycoprotein IgM > 20 but <40)
2 Answers available
Would you give antithrombin concentrate for surgical VTE prophylaxis in case of congenital AT deficiency?
1 Answer available
How do you manage patients who develop minor antigen antibodies and require multiple blood transfusions?
e.g. K, Fya, s, etc
1 Answer available
How do you manage a patient with sickle cell disease during pregnancy?
2 Answers available
Would you anticoagulate recurrent venous thromboembolism in a patient with Ehlers Danlos syndrome?
How would the approach differ if the patient had a significant bleeding phenotype vs only minor bruising and mucosal bleeding?
1 Answer available
What are your recommendations for management of patients with familial polycythemia due to EPOR mutation during pregnancy?
1 Answer available
Would you retry rituximab in steroid refractory warm autoimmune hemolytic anemia which responded to rituximab before?
Last rituximab 6 months ago
1 Answer available
Would you check vitamin B6 routinely in the work up of anemia?
1 Answer available
How do you approach heparin management in patients who have suprathetherapeutic Xa levels on minimal heparin?
1 Answer available
Do you repeat antiphospholipid antibody testing in a patient that previously met criteria for APLS?
If so, how long after diagnosis do you do so? 
1 Answer available
When do you consider plasma exchange for multiorgan failure in a patient with sickle cell disease?
2 Answers available
Do you recommend routine use of Evusheld for pre-exposure prophylaxis for patients on immunosuppression?
Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?
1 Answer available
Are there any situations you would recommend prophylactic anticoagulation for a patient with Factor V heterozygosity?
FVL heterozygotes are often treated similarly to the general population. Aside from avoiding other VTE risk factors, are there situations where prophy...
1 Answer available
In which platelet function disorders would you consider use of Novoseven as opposed to platelet transfusion?
Are there particular clinical scenarios that would affect your decision?
1 Answer available
Should we recommend the COVID-19 booster vaccine to patients who had a DVT or any other complications such as hemolytic anemia or thrombocytopenia from prior vaccine doses?
2 Answers available
In a patient with a heterozygous prothrombin gene mutation who has COVID with minimal symptoms, do you recommend prophylactic and/or therapeutic anticoagulation?
1 Answer available
How do you manage drug-induced thrombocytopenia when the implicated drug is essential?
e.g. DITP from eptifibatide after a cardiac intervention
1 Answer available
For treatment of ITP, what would you add to dexamethasone to achieve the fastest recovery in a patient waiting for a procedure?
IVIG, TPO, or other agents?
1 Answer available
When would you consider stopping chronic transfusion therapy in a sickle cell patient with history of abnormal TCDs but no stroke?
1 Answer available
How do you approach relapsed idiopathic HLH?
2 Answers available
How will you use Pola-R-CHP in the frontline treatment of DLBCL?
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...
2 Answers available
What are contraindications for growth factors in patients with hematologic malignancies?
2 Answers available
Do you routinely check platelet counts after COVID-19 vaccines in patients with chronic ITP?
1 Answer available
Does testing for elevated serum homocysteine have any relevance in thrombophilia management?
What should be done with a high level?
1 Answer available
How do you counsel male-to-female transgender patients on the VTE risk of hormonal therapy?
1 Answer available
How do you manage a patient with superficial venous thrombosis with close proximity (<3 cm) to deep veins and an inherited thrombophilia ?
Would you offer indefinite anticoagulation if the event is unprovoked and the patient has low bleeding risk? 
1 Answer available
Is there experience/reports of using voxelotor in sickle cell patients who are Jehovah Witnesses with few crises but who have fatigue and/or dyspnea?
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...
1 Answer available
Do you routinely check for copper deficiency as part of workup for bicytopenia with leukopenia/anemia or pancytopenia?
1 Answer available
How would you approach moderate neutropenia (ANC < 1000) in a solid organ transplant recipient?
Is there a particular sequence you would adjust contributing antirejection or antimicrobial medications? Is the use of G-CSF appropriate and at what c...
2 Answers available
What is the role of hydroxyurea in variant sickle cell genotypes?
Hydroxyurea is demonstrated to reduce complications and improve long-term outcomes in severe genotypes HbSS and sickle beta0 thalassemia. What clinica...
2 Answers available
How do you diagnose sickle hepatopathy?
1 Answer available
What is your approach to a patient with positive antiphospholipid antibodies who otherwise do not meet clinical criteria for APS?
What if the patient is triple-positive or has continued seropositivity on repeat lab testing? What is the appropriate interval of monitoring and does ...
3 Answers available
Do you utilize D-dimer to inform anticoagulation duration in the treatment of VTE?
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...
2 Answers available
How would you manage VTE in a patient with bleeding disorder such as hemophilia?
Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?
1 Answer available
How would you approach a young person with JAK2 V617F positive essential thrombocytosis with otherwise low risk features?
Would you get bone marrow biopsy periodically? Would your approach change based off specific age or platelet count?  
1 Answer available
What is the maximum pRBC volume you can transfuse when performing a manual exchange transfusion in an adult-sized patient with sickle cell disease?
1 Answer available
How do you approach treatment of vasculitis in a sickle cell disease patient?
There are multiple difficulties that could be seen: steroids can precipitate a sickle cell crisis, vasculitis and sickle cell can produce similar clin...
1 Answer available
How often should you repeat iron testing in patients with hemochromatosis, not on phlebotomy?
Patient with ferritin level <1000 ng/mL and no evidence of end-organ damage
1 Answer available
Do you use premedications (acetaminophen, diphenhydramine) before pRBC and plt transfusions to prevent febrile nonhemolytic transfusion reactions and allergic reactions?
Does manipulation of blood products (leukoreduction, irradiated) affect your approach? There is growing evidence that routine premedication (at least ...
1 Answer available
Under what circumstances would you consider anticoagulation in a young female patient with persistently elevated factor XI activity?
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 ...
1 Answer available
Should assessing for a MTHFR mutation be part of the thrombophilia evaluation in a patient presenting with a thrombus?
1 Answer available
How would you approach immunosuppression for patients with severe aplastic anemia who are not transplant or ATG candidates?
Such as patients who are frail, elderly, renally impaired? Would you consider sirolimus over cyclosporine or tacrolimus for safer nephrotoxicity prof...
1 Answer available
Are there any reasons to consider a prolonged course of steroids with taper over a shorter course of pulsed steroids in the treatment of ITP?
For example, do we prefer one regimen over the other in patients with a bleeding history or who have relapsed after a lengthy remission?
1 Answer available
Is there any role for iron chelation in a patient with iatrogenic transfusion-induced iron overload such as in patients with end-stage kidney or liver disease?
Does transplant eligibility make a difference for management?
1 Answer available
How would you approach chronic isolated severe non-cyclic neutropenia with negative bone marrow and rheumatologic work-up?
Is there a role for empiric antibiotics if there is history of opportunistic infection?
1 Answer available
When would you consider upfront eculizumab for sickle cell hyperhemolysis?
How long after eculizumab infusion would you wait before giving blood transfusions?
0 Answers available
What additional testing, if any, should be performed for an adolescent patient with heavy menstrual bleeding and a negative von Willebrand disease evaluation?
1 Answer available
How would you manage a patient with antiphospholipid syndrome in the setting of severe steroid-refractory thrombocytopenia?
Especially in a triple-positive patient with an acute ischemic stroke who may have urgency for anticoagulation with high bleeding risk and severe thro...
2 Answers available
How can healthcare providers better serve as allies of the sickle cell community?
Has your medical practice taken any steps either in community outreach or within the clinic to show support for this medically vulnerable population, ...
2 Answers available
Is there a role for G-CSF treatment for SLE patients with persistent neutropenia?
1 Answer available
In which patients with atypical HUS would you consider eculizumab discontinuation?
Given the high cost of eculizumab, are there patient characteristics that inform which patients, if any, should be on indefinite therapy versus a time...
2 Answers available
How do you manage a delayed hemolytic transfusion reaction in a patient with sickle cell disease?
How do you manage an uncomplicated DHTFR versus a hyperhemolysis?
1 Answer available
What is your threshold for pursuing bone marrow biopsy in a lupus patient with cytopenias?
2 Answers available
How do you approach the management of a patient with symptomatic iron deficiency anemia who is intolerant of iron?
Such as a patient who cannot tolerate oral iron and has had a anaphylaxis to intravenous iron
4 Answers available
What is the target ferritin level for patients with hereditary hemochromatosis and signs of end-organ damage?
For example, a patient with hypogonadism unless it matters which organ is involved. Are other markers of iron storage useful in guiding therapy?
2 Answers available
How do you approach anticoagulation in patients with catastrophic antiphospholipid syndrome and thrombocytopenia?
1 Answer available
When would you consider splenectomy or other immunosuppressive/cytotoxic therapy for steroid-refractory warm autoimmune hemolytic anemia?
For example, in a patient who is steroid-refractory, requiring regular transfusion, and has not had response to rituximab after several weeks.
1 Answer available
What are your thoughts on adding mycophenolate to steroids in the first line treatment of ITP based on the results of the FLIGHT trial?
Presented at ASH: FLIGHT trial
1 Answer available
When would you perform a thrombophilia workup in a pediatric patient presenting with VTE?
1 Answer available
How would you manage OCPs in a patient who develops a VTE while on treatment?
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...
1 Answer available
Is there a role for anti-neutrophil antibody testing in the workup of neutropenia?
If autoimmune neutropenia already suspected, is this test informative or unnecessary?
1 Answer available
Do hemoglobin S levels always correlate with SCD phenotype?
What is the lowest level you have seen with uncomplicated or complicated crises?
4 Answers available
How do you approach diagnosing a patient with Iron Refractory Iron Deficiency Anemia (IRIDA)?
Do you go straight to TMPRSS2 genetic testing or what other lab testing (e.g. hepcidin) could be helpful?
1 Answer available
How do you manage VTE in the setting of persistent severe thrombocytopenia?
Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?
3 Answers available
Is there any role for direct oral anticoagulants in the treatment of antiphospholipid syndrome?
What if this was "triple-negative" antiphospholipid syndrome?
2 Answers available
Would you anticoagulate a patient with an isolated arterial thrombosis in the setting of an inherited thrombophilia?
Does your opinion change based on the specific underlying inherited thrombophilia? The original case was a central retinal artery occlusion in a patie...
2 Answers available
Would you recommend anticoagulation prophylaxis for a pediatric patient admitted with COVID-19?
3 Answers available
How do you assess whether an early-stage Hodgkin's patient is unfavorable?
The unfavorable risk factors for stage I-II Classic Hodgkin's Lymphoma differ depending on the cooperative group (GHSG, EORTC, NCCN), which criteria d...
1 Answer available


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