You Make the Call
Each month in “You Make the Call,” we’ll pick a challenging clinical question
submitted through the Consult-a-Colleague program and post the expert’s
response. But, what would YOU do? We’ll also pose a submitted question
and ask you to send your responses. See how your answer matches up to the
experts in the next print issue.
This month, Ann LaCasce, MD, weighs in about recommending a bone marrow
biopsy and whether or not to give G-CSF.
Consult a Colleague
Through ASH
Consult a Colleague is a service for ASH
members that helps facilitate the exchange of information between hematologists and their peers. ASH members
can seek consultation on clinical cases
from qualified experts in 11 categories:
Clinical Dilemma:
A 44-year-old male with no significant past medical history presented after having palpated on himself supraclavicular adenopathy. A biopsy showed Hodgkin lymphoma, nodular sclerosis subtype. A CT showed neck and
hilar adenopathy, with a maximum size of 2-3 cm. A PET scan also showed bone disease, as well as supraclavicular, mediastinal, and right hilar adenopathy as described above. Would you recommend a bone marrow biopsy
to complete staging? The CBC shows no cytopenias, and the stage is already stage IV disease. I don’t see how it
will change the management. Would you give G-CSF? There is conflicting evidence regarding its association with
bleomycin toxicity of the lung.
• Anemias
• Hematopoietic cell
transplantation
• Hemoglobinopathies
• Hemostasis/thrombosis
• Lymphomas
• Lymphoproliferative disorders
• Leukemias
Experts Make the Call
• Multiple myeloma & Waldenström
macroglobulinemia
Ann S. LaCasce, MD
Director, Dana-Farber/Partners
CancerCare Hematology-Medical
Oncology Fellowship Program;
Senior Physician;
Assistant Professor of Medicine
Harvard Medical School
Boston, Massachusetts
• Myeloproliferative Disorders
• Myelodysplastic Syndromes
• Thrombocytopenias
Assigned volunteers (“colleagues”) will
respond to inquiries within two business
days (either by email or phone).
I agree that a bone marrow biopsy will not
change therapy and could easily miss the
disease. We don’t give G-CSF unless a patient
develops febrile neutropenia or has recurrent
infections, in which case we would use as
little G-CSF as possible (usually on days 5-8
or 9).
Have a puzzling clinical dilemma?
Submit a question, and read more
about Consult-a-Colleague volunteers at
hematology.org/Clinicians/Consult.aspx
or scan the QR code.
*If you have a request related to a
hematologic disorder not listed here, please
email your recommendation to ashconsult@
hematology.org so it can be considered for
addition in the future.
DISCLAIMER: ASH does not recommend or endorse any specific
tests, physicians, products, procedures, or opinions, and disclaims
any representation, warranty, or guaranty as to the same. Reliance on any
information provided in this article is solely at your own risk.
Next Month’s Clinical Dilemma:
I was asked to see a 41-year-old male
with Wilson’s disease. He has resulting cirrhosis and hypersplenism with a
chronic pancytopenia. His leukopenia is
worsening with an absolute neutrophil
32
ASH Clinical News
count of 400. His hemoglobin is mildly
decreased by 2 g/dL currently at 8.3, and
his platelet count is stable at 73,000. He
is continuing chronic zinc therapy for his
Wilson’s disease. I am concerned that
his zinc therapy has resulted in copper
depletion as a cause for his worsened
neutropenia, which more typically
remains with an ANC of 1700. A vitamin
B12 level and folic acid are normal, his
LDH is normal, and his absolute reticulocyte count is 160 (6.4%). I am interested
in further thoughts on evaluation and
treatment.
How would you respond? Email us at
[email protected].
March 2016