Questions discussed in this category
How often does this occur and does this lower your suspicion for a "true" or clinically significant lupus anticoagulant?
Is there a target IgG level to aim for?
What should hematologists be aware of in monitoring these patients?
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 ...
Presuming good medication adherence.
Do you consider starting Ursodiol? Do you perform routine abdominal ultrasound to monitor for cholelithiasis?
Is parasitemia >10% and severe hemolysis with Hb less than 7 enough to initiate this?
Do you discuss the risk of sickle cell crises with G-CSF? What about for patients with sickle cell trait?
Thrombophilia testing, including JAK2 is negative. When would you stop anticoagulation?
If not, has your practice changed to use vWF replacement therapy more routinely for perioperative or acute bleeding management? Do you still perform D...
Would you consider chronic RBC exchange versus HU?
Are there specific guidelines for managing this patient population?
When do you determine SSRI therapy is unsafe to pursue in such situations?
rWGS did not demonstrate any HLH definable or associated mutations.
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...
Do you do additional workup for venous obstruction or any other different testing/evaluation?
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.
How would your recommendation change if the patient has H63 homozygous mutation?
When would you consider using anticoagulation and for how long?
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...
Antifibrinolytic therapy alone +/- DDAVP?
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...
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...
How would you counsel the patient if he/she wants to continue on steroids?
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?
Anemia is secondary to menorrhagia. No gynecologic interventions were possible.
No transfusion dependence but has hemoglobin in the 8-9 g/dl range.
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)?
What else would you consider in your differential?
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...
No prior thrombosis; no family history of thrombosis. As per endocrine, the only useful therapy for the osteoporosis is estrogen.
How is this entity distinct from other secondary HLH entities?
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?
ADAMTS13 level <5%
Inhibitor level <1
E.g. pulmonary embolism, portal vein thrombosis, cerebral venous sinus 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...
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
Although testing was not indicated, what do u do with these results?
Other hypercoagulability work up negative
Would the answer differ if the index event was arterial vs venous?
Do you advise against combination OCPs?
What type, dosage, and duration of treatment do you use? How does your practice change when there is an inhibitor?
What are indications to order gene mutation studies (e.g. ELANE) and how would it help the patient?
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...
Is thrombotic risk too significant? Patient failed OCPs.
For example, if TSAT is less than 20% but ferritin is over 200.
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...
i.e. long car rides or plane rides
CRP 39 mg/L (normal < 10) and normal ESR
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?
(e.g. beta 2 glycoprotein IgM > 20 but <40)
How would the approach differ if the patient had a significant bleeding phenotype vs only minor bruising and mucosal bleeding?
Last rituximab 6 months ago
If so, how long after diagnosis do you do so?
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...
Are there particular clinical scenarios that would affect your decision?
e.g. DITP from eptifibatide after a cardiac intervention
IVIG, TPO, or other agents?
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...
What should be done with a high level?
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?
Does transplant eligibility make a difference for management?
Is there a role for empiric antibiotics if there is history of opportunistic infection?
How long after eculizumab infusion would you wait before giving blood transfusions?
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...
How do you manage an uncomplicated DHTFR versus a hyperhemolysis?
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.
Presented at ASH: FLIGHT trial
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?
What if this was "triple-negative" antiphospholipid syndrome?
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...
2237821913160611927721666218352138015828214852101317110213862075716312211032094120638198411665119644171982070520362194382060419530168161706119968198911981519642192931946219628172191042313842960514321172751784618666186711855318269858093881558015761133001598914914129101740713291179701789817165174347520172811710317096171091467011786156448610162251661716563161861621716195159401542916128160071280193771598815382158141408115316157371481313479112961563815435153268324148921244915176150221510914873131601230214769148681484810180147599376146841400013997139991434114049145701396812597139981406913903139021391213740112181328413520135111345312847132621305212952129141288912806127871275712580125901255712267121611232812259115678133104041204910666120001197511798112041164311597115709759115698711112761112711152812583641098010930818792861085510137960998561055210476104501044810420104081034110302860610220996397629706963694519235904089248952893786438911887987818688832686848664864086358114803472358029712970036788
Papers discussed in this category
Acta Paediatr., 2020 Mar 23
Br. J. Haematol., 2020 Apr 30
Blood,
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
JAMA,
N Engl J Med,
Blood, 2015 Dec 22
Contraception, 2016 May 03
BMJ, 2008 May 20
Circulation,
Journal of thrombosis and haemostasis : JTH, 2018-06-07
American journal of hematology, 2008-08
Blood, 2010-07-22
Am J Gastroenterol,
Blood, 2017-07-20
Clin J Am Soc Nephrol, 2016 Oct 31
Blood, 2020 Dec 03
Rheumatol Int, 2019 Apr 30
Clin Exp Rheumatol, 2012 Sep 25
Wien Klin Wochenschr,
J Rheumatol, 2006 Jul 01
Semin Arthritis Rheum,
Am J Prev Med,
J Natl Med Assoc,
J Adv Nurs, 2015 Sep 09
Issues Ment Health Nurs, 2018 Apr 13
JAMA Netw Open, 2020 May 01
Emerg Infect Dis, 2020 Jul 08
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,
Transfus Med Rev,
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
Lancet (London, England), 2016-02-13
Blood Adv,
Blood, 2019-06-06
Eur J Haematol, 2021 Feb 17
Transfusion, 2017 May 03
Autoimmun Rev, 2017 Sep 09
Br J Haematol, 2013 Aug 02
Blood Adv, 2020 Jan 28
Blood, 2019 Apr 25
J Clin Med, 2020 Nov 23
Am J Hematol, 2012 May 28
Circulation, 2022 Nov 06
Circulation, 2022 Nov 06
Lupus, 2021 May 27
Journal of the National Medical Association, 2009-10
Blood,
Lancet,
Eur J Dermatol,
Am J Hematol, 2019 Aug 07
JCO Precis Oncol, 2022 Apr
Blood, 2006-05-01
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-02-01
Blood, 2017-03-09
The Lancet. Oncology, 2015-10
N Engl J Med, 2013 Jul 11
Blood, 2012 Jun 19
Genetic epidemiology, 2016-09
American journal of hematology, 2019-03
Blood, 2021 Jan 07
Blood, 2019-04-11
N Engl J Med, 2022 Dec 11
Blood, 2013-08-01
Circulation, 2003 Jun 17
Haematologica, 2007 Feb
PLoS One, 2015 Dec 30
Int J Lab Hematol, 2021 Oct 05
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-11-01
Blood, 2018 Apr 5
Blood Adv, 2021 Aug 24
Pediatric blood & cancer, 2011-01
British journal of haematology, 1987-05
Blood, 1983 Nov
Klin Wochenschr, 1991 Oct 02
Hemoglobin, 1992
Blood, 2003 Mar 27
N Engl J Med, 2019 Sep 19
Am J Med, 1990 Mar
Hepatology, 1996 Jun
Hepatology, 1986 Jul-Aug
Gut, 1992 Jan
Blood, 2018 Sep 10
Pediatric blood & cancer, 2018-10
Biol Blood Marrow Transplant, 2020 Mar
Front Immunol, 2020 Apr 03
Transplantation and cellular therapy, 2021 Feb 06
Frontiers in immunology, 2024 Apr 08
Leukemia & lymphoma, 2021 May 20
Expert review of hematology, 2021 Dec 01
Drug safety, 2015 Dec
Thrombosis journal, 2023 Jun 23
Hematology. American Society of Hematology. Education Program, 2015
British journal of haematology, 2015-10
Seminars in hematology, 2002-04
Blood, 2002 Jan 01
Ther Adv Musculoskelet Dis, 2020 Nov 24
Blood advances, 2024 Aug 13
Annals of oncology : official journal of the European Society for Medical Oncology, 2018 Sep 01
Journal of pharmacy practice, 2021 Nov 08
Haematologica, 2019 Jan 03
Frontiers in immunology, 2023 Jun 22
The New England journal of medicine, 1994-03-17
Haematologica, 2013-09
N Engl J Med, 2018 Jul 19
N Engl J Med, 2019 Aug 8
American journal of hematology, 2022 Sep 08
Journal of hospital medicine, 2019-01
The New England journal of medicine, 2019 Feb 18
Phlebology, 2020 Mar 02
VASA. Zeitschrift fur Gefasskrankheiten, 2001 Jul
Journal of vascular surgery, 2000 Nov
Circulation. Cardiovascular interventions, 2015-10
Research and practice in thrombosis and haemostasis, 2018 Oct 19
Thrombosis and haemostasis, 2019 Oct 28
Journal of thrombosis and haemostasis : JTH, 2021 Apr 01
Journal of medical case reports, 2014 Mar 04
JAMA, 2023 Aug 8
Blood, 2017 Jan 31
Arthritis & rheumatology (Hoboken, N.J.), 2023 Jul 24
Blood advances, 2020 Jun 23
The New England journal of medicine, 2008-03-27
The New England journal of medicine, 2020 Jun 25
Frontiers in genetics, 2022 Aug 26
Pharmacological research, 2016 Aug 10
The Annals of pharmacotherapy, 2018 Aug 06
Blood, 2024 Mar 21
European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes, 2021 Dec 06
Stroke, 2023 Sep 07
Stroke, 2024 Jan 29
Blood, 1998-01-01
Blood advances, 2020 Apr 28
The Journal of clinical endocrinology and metabolism, 2018 May 01
The Journal of urology, 2022 Jan 20
Haematologica, 2009 Oct 14
American journal of hematology, 2023 Jul 20
European journal of haematology, 2023 Aug 27
Journal of thrombosis and haemostasis : JTH, 2020 Nov
Journal of thrombosis and haemostasis : JTH, 2023 Aug 18