Hematology

  • If a patient has cirrhosis, should I correct coagulation abnormalities before a minor invasive procedure?
    Emily B. Wolf, MD, Marie Plante, MD and Razvan M. Chirila, MD
    Cleveland Clinic Journal of Medicine September 2023, 90 (9) 541-543; DOI: https://doi.org/10.3949/ccjm.90a.23005

    Hemostatic abnormalities in cirrhosis can include thrombocytopenia, prolonged prothrombin time, prolonged activated partial thromboplastin time, elevated international normalized ratio, and decreased fibrinogen.

  • Unilateral green pleural effusion in a 22-year-old woman
    Sauradeep Sarkar, MD, Utsav Shrestha, MD, Huda Elzahrany, MD and Bathmapriya Balakrishnan, BMedSci, BMBS, FCCP
    Cleveland Clinic Journal of Medicine August 2023, 90 (8) 491-498; DOI: https://doi.org/10.3949/ccjm.90a.22097

    Chills, night sweats, palpitations, and a 5-lb weight loss, preceded by 6 months of progressive dyspnea, fatigue, and reduced exercise tolerance. What is the diagnosis?

  • Late complications after allogeneic hematopoietic cell transplant: What primary care physicians can do
    Lauren M. Granat, DO, MS, Mariah Ondeck, MD, Bennett Osantowski, MD, Michael Sheu, MD, Vishwanath Ganesan, MD, Seth Rotz, MD and Betty K. Hamilton, MD
    Cleveland Clinic Journal of Medicine August 2023, 90 (8) 499-508; DOI: https://doi.org/10.3949/ccjm.90a.23006

    Cardiovascular, metabolic, endocrine, rheumatologic, orthopedic, infectious, neurologic, and cognitive complications are examined, as well as secondary malignancies, psychiatric disorders, and impairments in quality of life and sexual health.

  • A 50-year-old man presents with shortness of breath
    Kaylee Watson, MD, David Wolinsky, MD, Mauricio Velez, MD and David Snipelisky, MD, FACC
    Cleveland Clinic Journal of Medicine February 2023, 90 (2) 95-101; DOI: https://doi.org/10.3949/ccjm.90a.22021

    Red flags included low voltage, normal sinus rhythm, and Q waves on electrocardiography, a history of carpal tunnel syndrome, and evidence of renal dysfunction.

  • A 60-year-old man with prostate cancer and embolic strokes
    Neha K. Reddy, MD, MA, Christian Scherer, DO, Samuel Kessel, MD, MBA and Alejandro Moreno, MBBS, MPH, JD, MACP
    Cleveland Clinic Journal of Medicine December 2022, 89 (12) 705-711; DOI: https://doi.org/10.3949/ccjm.89a.21079

    Step-by-step evaluation of a patient with stage IV prostate cancer and embolic stroke, but no history of heart valve disease, arrhythmia, or coagulopathy.

  • Hypophosphatemia in a patient with an eating disorder
    Maxwell J. Uetz, MD, Christopher D. Knapp, MD, MPH and Samuel T. Ives, MD
    Cleveland Clinic Journal of Medicine November 2022, 89 (11) 625-629; DOI: https://doi.org/10.3949/ccjm.89a.21074

    A 32-year-old woman referred from an eating disorder treatment center reported memory difficulty, trouble concentrating, and feeling “hazy.” She was taking oral potassium phosphate 3 times daily.

  • When should antithrombotic therapy be resumed after gastrointestinal bleeding?
    Dushyant Singh Dahiya, MD, Asim Kichloo, MD, FACP, Rawan Amir, MD and Farah Wani, MD
    Cleveland Clinic Journal of Medicine November 2022, 89 (11) 630-633; DOI: https://doi.org/10.3949/ccjm.89a.20189

    The timing should be individualized after considering factors related to the bleeding event, thromboembolic risk, and patient comorbidities.

  • Blue sclera: An overlooked finding of iron deficiency
    Yasuhiro Kano, MD
    Cleveland Clinic Journal of Medicine October 2022, 89 (10) 549-550; DOI: https://doi.org/10.3949/ccjm.89a.22045

    The pathogenesis is thought to involve thinning of collagen fibers of the sclera due to iron deficiency, allowing the bluish color of the underlying uvea to become visible.

  • A 65-year-old man with melena and a blood disorder
    Monia E. Werlang, MD, Marilia L. Montenegro, MD and Bhaumik Brahmbhatt, MD, MBBS
    Cleveland Clinic Journal of Medicine October 2022, 89 (10) 573-578; DOI: https://doi.org/10.3949/ccjm.89a.20175

    The patient had chronic anemia related to primary myelofibrosis and was being treated with epoetin alfa and ruxolitinib, with blood transfusions every other week.

  • Cirrhotic coagulopathy: A rebalanced hemostasis
    Cirrhotic coagulopathy: A rebalanced hemostasis
    Achintya D. Singh, MD, MBBS, Simon R. Mucha, MD and Christina C. Lindenmeyer, MD
    Cleveland Clinic Journal of Medicine September 2022, 89 (9) 523-533; DOI: https://doi.org/10.3949/ccjm.89a.21018

    Cirrhosis affects all 3 phases of coagulation, leading to a delicate new equilibrium, easily disturbed and tipped toward either bleeding or thrombosis by acute events such as infection, renal failure, and invasive procedures.

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