Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Onco-Cardiology: Focus on Cardiac Complications of Hematologic Treatments

Recent progress in chemotherapy and immunotherapy for hematological malignancies has improved cancer survivorship over the past few decades. However, cardiovascular disease is a prominent cause of death in many cancer survivors, with emerging cardiotoxicity from cancer therapies being a significant contributor to the morbidity and mortality of this population. Onco-cardiology as a subspecialty of cardiology that seeks to identify, prevent, diagnose and manage the cardiovascular complications…

Aging and Hematologic Disorders

The population is aging, and it is estimated more than 23.4% of the population in the United States will be older than 65 years by 2060. Many hematologic disorders, including anemia and hematologic malignancies such as myelodysplastic disorders, myeloproliferative neoplasms, chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), multiple myeloma, and certain types of lymphoma, are more common with aging. Compared with younger adults, older adults…

The Spleen and Its Disorders

Galen described the spleen as the “organ of mystery,” with functions related to mood and good or ill humors. It was not until the 18th century that the spleen’s relationship to the immune and hematologic systems was appreciated. The complexities and multiplicity of splenic function continue to be the focus of research and observation. Although many of its functions overlap with, or can be assumed by…

Hematologic Problems in the Surgical Patient: Bleeding and Thrombosis

The management of hematological issues in surgical patients can be challenging due to myriad factors. Bleeding and thrombotic issues may be present concurrently, and the impact of underlying pathological issues may be masked by the primary pathology warranting surgery. Nevertheless, the role of the hematologist in the management of these patients is to aid patients with a history of bleeding or thrombosis. This chapter will review:…

Hematologic Aspects of Parasitic Diseases

Parasitic diseases are not common in medical, let alone hematologic, practice in North America or Europe. However, much of the world’s population is infected by and becomes symptomatic as a result of a plethora of parasites, and many of these infections represent global public health problems. Although, some significant parasitic diseases are transmitted in temperate climates, the majority of parasites of significance to human health are…

Hematologic Findings And Consequences Of Novel Coronavirus (SARS-COV-2) Infection

At the end of 2019, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lead to a cluster of infections in Wuhan. China. The disease caused by this virus was designated as coronavirus-disease-2019 (COVID-19) by the World Health Organization (WHO). COVID-19 spread globally and went on to infect millions of people on all continents except Antarctica, causing an unprecedented global impact. As of February 2021,…

Hematologic Manifestations of HIV/AIDS

Human immunodeficiency virus (HIV) infection is associated with a number of hematologic complications throughout the course of the disease. To a certain extent, these complications depend on the stage of the disease and how well controlled HIV infection is but to a certain extent it does not. In untreated infection, the major hematologic complications were cytopenias, either isolated or multiple simultaneously. As combination antiretroviral therapy (ART)…

Hematologic Manifestations of Solid Tumors

Hematologic abnormalities are commonly seen among patients with malignancy. These derangements range from the incidental to the life-threatening and may complicate management or prompt the initiation of additional or alternative therapies. Hematologic abnormalities can be seen as the initial manifestation of cancer, providing a crucial diagnostic clue. In addition, the hematologic aspects of cancer, and the therapies that we use to treat these irregularities, can provide…

Hematologic Manifestations of End-Organ Failure

The hematologic system is intricately connected to other vital organs. There are multiple pathways that affect the red blood cells (RBCs), white blood cells, platelets, and hemostasis. This chapter will discuss the hematologic abnormalities encountered in liver disease, renal disease, splenic dysfunction, heart failure, respiratory disease, and endocrinopathies. For further details about the individual blood systems affected, the reader should refer to the specific chapters dealing…

Hematologic Changes in Pregnancy

Hematologic conditions are often seen during pregnancy as part of normal physiology and complications of varying severity. The primary physiologic, hematologic changes during pregnancy relate to the expansion of plasma volume and the prothrombotic state that develops as the pregnancy advances. They are thought to prepare the mother and fetus for eventual placental separation. Understanding the complex physiology of pregnancy and the interplay with hematology facilitates…

Bleeding And Clotting Disorders In Pediatrics

The neonatal and pediatric stages are periods of rapid physiologic changes, some of which affect the hemostatic system. The hemostatic system is a dynamic system that evolves gradually from birth into the mature adult form. Evaluation of bleeding and clotting disorders in children requires an understanding of the evolution of physiologic normal values for age, the congenital disorders that present in early life, and the common…

Atrial Fibrillation

Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia, affecting approximately 3% of adults worldwide. Its prevalence and incidence are rising continuously with the increasingly aging population. AF is associated with impaired prognosis, increased risk of all-cause mortality, stroke, heart failure, and hospital admissions, in addition to poor quality of life. Importantly, AF should not be considered in isolation regarding the process of prevention, detection,…

Peripheral Artery Disease

Peripheral artery disease (PAD) is an important manifestation of systemic atherosclerosis with significant morbidity and mortality.PAD affects the lower extremities and is defined as a stenosis or occlusion in the aorta or the arteries supplying blood to the legs, including the iliac, femoral, popliteal, or infrapopliteal vessels (peroneal, posterior tibial, and anterior tibial arteries). Stenosis is typically caused by atherosclerosis. Nonatherosclerotic causes of vascular disease also…

Acute Coronary Syndromes

Acute coronary syndrome (ACS) leads to millions of hospital admissions worldwide each year and is a leading cause of death. Antithrombotic therapies are a cornerstone in the immediate and long-term management of ACS, reducing the risk of myocardial infarction (MI) and death in both medically and invasively managed patients. This chapter reviews fibrinolytic, antiplatelet, and anticoagulant therapies in the treatment of patients with ACS and provides…

Stroke

Stroke is the second leading cause of mortality worldwide and a leading cause of acquired adult disability. Primary stroke subtypes include ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Each stroke subtype has differing etiologies, outcomes, and management strategies. In the past 30 years, there have been major advances in the diagnosis (emergence of widely available neuroimaging) and treatment of acute stroke. In addition, there…

Antithrombotic Drugs

Arterial or venous thromboembolism is a major cause of morbidity and mortality. Arterial thrombosis is the most common cause of acute myocardial infarction, ischemic stroke, and limb gangrene, whereas deep vein thrombosis can lead to pulmonary embolism, which can be fatal, and to post-thrombotic syndrome. Most arterial thrombi are superimposed on disrupted atherosclerotic plaque because plaque rupture exposes thrombogenic material in the plaque core to the…

Atherothrombosis

Morbidity and mortality from atherosclerosis, the pathologic process underlying acute myocardial infarction, sudden death, stroke, and limb loss, represent an enormous burden on society and health care systems (see Chapter 144, Chapter 145, Chapter 146 ). Even though death rates from heart attack and stroke have dropped precipitously over the past 48 years (68% and 77%, respectively), cardiovascular disease (CVD) is still the number one cause…

Prevention and Treatment of Venous Thromboembolism in Pregnancy

Pregnant persons and those who are postpartum are at increased risk of venous thromboembolism (VTE). Although pregnancy-related VTE can affect any part of the venous circulation, as in the non-pregnant population, it most commonly manifests as deep vein thrombosis (DVT) or pulmonary embolism (PE). Management of pregnancy-related VTE is complicated as the diagnosis, prevention, and treatment of pregnancy-related VTE must consider fetal, as well as maternal,…

Venous Thromboembolism

Venous thromboembolism (VTE) encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT commonly affects the deep veins of the legs, and infrequently involves veins at other anatomical sites (such as upper extremity, splanchnic, or cerebral veins). Thrombotic occlusion of the deep veins impairs drainage of blood, thereby resulting in pain and swelling distal to the obstruction. Embolization of thrombus from deep veins in the leg…

Antiphospholipid Syndrome

Antiphospholipid (aPL) syndrome (APS) is an autoimmune thrombophilic syndrome for which definitive disease mechanisms have not been established. The condition is defined and diagnosed by a constellation of clinical and laboratory criteria, detailed below. This chapter reviews the current understanding of pathogenic mechanisms, the current diagnostic tests for the condition, its clinical manifestations, and treatment approaches. Definition of Antiphospholipid Syndrome APS is an autoimmune thrombophilic condition…