1.
Mohty M, Nagler A, Savani B, Bazarbachi A, Ron TB. Clinical Hematology International: Case Reports – capturing the first signals of clinical innovation in hematology. CHI Case Reports. 2026;1(1-2):1-5.

Abstract

In an era of increasingly complex and individualized therapies, the future of hematology will be shaped not only by trials but by the precise documentation of individual patient experiences. CHI: CR is designed to capture these signals early, rigorously, and globally.

Introduction

Clinical Hematology International: Case Reports (CHI:CR) is designed to capture and structure the first signals of clinical innovation in hematology at the level where they emerge: the individual patient.

Clinical hematology is among the most rapidly evolving medical specialties. Targeted therapies, chimeric antigen receptor T-cell therapy, precision genomics, and novel immunotherapeutics have reshaped the diagnosis and management of both malignant and non-malignant blood diseases within a single generation.1,2 Yet the earliest evidence of these advances, a first-in-field toxicity signal, an unexpected remission, a diagnostic breakthrough, almost invariably surfaces not in a clinical trial, but at the bedside, in a single patient.3

Clinical Hematology International (CHI), the official open-access journal of the International Academy for Clinical Hematology International was established in 2019 to serve as the premier forum for clinical reviews, guidelines, and original research in the field.4 As the breadth and granularity of hematological case observations have grown, the editors have recognized that a dedicated sister journal, purpose-built for case-level knowledge, is both strategically warranted and scientifically essential. CHI:CR is that journal.

Why CHI:CR, and Why Now?

Case reports remain the primary source of first-in-field clinical insights in medicine. The initial characterizations of chronic myelogenous leukemia, thrombotic thrombocytopenic purpura, and, more recently, immune checkpoint inhibitor (ICI)-associated aplastic anemia and vaccine-induced immune thrombocytopenia and thrombosis (VITT) each emerged through meticulous individual patient documentation.5,6 In hematology, where disease heterogeneity is exceptional and rare presentations are common, the case report is not a peripheral genre; it is a core engine.

Despite this, the publication environment for hematology case reports has narrowed. Major journals have progressively restricted or eliminated case report sections in favor of high-impact original research, creating a growing disconnect between clinical observation and published evidence.7 Clinically meaningful cases, rare diagnoses, novel toxicity profiles, and atypical treatment responses are documented internally but never reach the literature. This represents a loss for patients, clinicians, and the scientific community alike.

CHI:CR aims to close this gap, with a scope, editorial positioning, and publication model specifically designed for case-level hematology evidence.

What Distinguishes CHI:CR

Three features define CHI: CR and differentiate it from general case report journals:

1. Hematology-exclusive focus. CHI:CR covers the full spectrum of clinical hematology, malignant and non-malignant, pediatric and adult, rare and common, within a single, specialist-curated platform. Reviewers are hematologists. Editorial standards reflect hematology-specific diagnostic and therapeutic complexity. Authors receive field-relevant feedback, not generalist commentary.

2. Hypothesis-generating positioning. CHI:CR is not a repository. Every submission is evaluated not only for its immediate clinical interest, but for the research question it raises. Authors are expected to articulate the broader lesson their case offers and, where appropriate, the hypothesis it generates for future investigation. The individual case is the beginning of an evidence chain, not its end.

3. A direct publication pipeline to CHI. As the official sister journal of CHI, CHI:CR creates a structured pathway from case observation to clinical evidence synthesis. Observations documented in CHI:CR may evolve into systematic reviews, meta-analyses, or clinical guidelines published in CHI. The two journals are editorially coordinated, with shared board membership and a shared mission: to advance the practice of clinical hematology through rigorous, open-access dissemination of knowledge.

Scope and Priority Case Categories

CHI:CR welcomes case reports and short case series (two to five patients) across all domains of clinical hematology. Priority categories, each illustrated with a representative example in the Appendix, include:

Rare and ultra-rare hematologic diseases

Conditions such as VEXAS syndrome, Diamond-Blackfan anemia, and congenital platelet disorders are characterized almost entirely through accumulated case-level documentation. CHI:CR provides a permanent, indexed home for these observations.8

Atypical presentations of common diseases

Acute myeloid leukemia presenting as isolated thrombocytopenia, or multiple myeloma with an unusual extramedullary pattern, can delay diagnosis and mislead clinical management. Documenting these presentations expands the field’s collective diagnostic awareness.9

Unexpected or paradoxical treatment responses

Off-label responses to approved agents, paradoxical disease acceleration, and acquired resistance mechanisms are among the most scientifically generative observations in clinical hematology and among the most likely to generate formal investigational hypotheses.10

Drug-induced cytopenias, ICI-associated hematologic immune-related adverse events, and chemotherapy-induced thrombotic microangiopathy represent categories in which the case report literature has been, and continues to be, the primary signal-detection mechanism.11

Infectious disease and hematology intersections

Secondary hemophagocytic lymphohistiocytosis infection-triggered autoimmune hemolytic anemia, and COVID-19-associated coagulopathy each illustrate how infectious events can unmask or precipitate hematological emergencies requiring prompt specialist recognition.12

Hematology in special populations

Pregnancy, pediatric patients, the elderly, and populations with genetically distinctive disease burdens (sickle cell disease, thalassemia syndromes, G6PD deficiency) are systematically underrepresented in clinical trials. Case reports remain the primary source of evidence for management decisions in these groups.13

Diagnostic challenges and novel diagnostic approaches

Diagnostic odysseys documenting the reasoning from presentation to diagnosis, and reports illustrating the clinical utility of next-generation sequencing, optical genome mapping, or advanced flow cytometry in ambiguous or complex cases, serve a critical educational function for the hematology community.14

Editorial Standards and Ethical Commitments

All submissions to CHI:CR will be required to follow the CARE (CAse REport) guidelines,15 which provide the international standard for structured, transparent case report presentation. Peer review will be conducted by at least two independent expert reviewers, with a target decision time of four weeks from submission.

CHI:CR upholds the highest ethical standards. Documented informed patient consent for publication, appropriate institutional approval, and full compliance with the Declaration of Helsinki16 are mandatory for all submissions. Patient anonymization will be rigorously assessed, with particular attention to rare or highly identifiable presentations.

Conclusion

CHI:CR is launched not as a supplement to existing hematology publishing, but as a dedicated infrastructure for a category of evidence that the field has long generated and too rarely preserved.

We invite hematologists, hematopathologists, oncologists, and allied health professionals worldwide to contribute their case observations to this journal, whether a first description of an emerging entity, an instructive diagnostic challenge, an unexpected treatment response, or a lesson hard-earned at the bedside.

In an era of increasingly complex and individualized therapies, the future of hematology will be shaped not only by trials but by the precise documentation of individual patient experiences. CHI: CR is designed to capture these signals early, rigorously, and globally.


Conflicts of Interest

The authors declare no conflicts of interest.

Funding

This editorial received no specific funding from any public, commercial, or not-for-profit agency.

Authors’ contribution – CRediT

Conceptualization: Mohamad Mohty (Equal), Tetsuzan B. Ron (Equal). Writing – original draft: Mohamad Mohty (Equal), Tetsuzan B. Ron (Equal). Writing – review & editing: Mohamad Mohty (Equal), Arnon Nagler (Equal), Bipin Savani (Equal), Ali Bazarbachi, Tetsuzan B. Ron (Equal).

Accepted: May 28, 2026 CDT

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Appendix: Illustrative Case Examples by Category

The following examples are provided for illustrative purposes to demonstrate the type and range of case reports that CHI:CR seeks to publish.

A.1, Rare Disease: VEXAS Syndrome

VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome, first described in 2020 through a genotype-first genomic approach [Beck et al., N Engl J Med 2020], exemplifies this category. Patients typically present with macrocytic anemia, thrombocytopenia, treatment-refractory inflammatory manifestations, and vacuolization of myeloid precursors on bone marrow biopsy. Because phenotypic expression is highly variable, case reports describing atypical presentations, late diagnoses, or novel treatment responses (e.g., azacitidine, ruxolitinib, allogeneic stem cell transplantation) are urgently needed to build the clinical characterization of this emerging entity.

A.2, Atypical Presentation: AML Presenting as Isolated Thrombocytopenia

Acute myeloid leukemia (AML) can rarely present with isolated thrombocytopenia and a near-normal white blood cell count, closely mimicking immune thrombocytopenia (ITP). Delayed bone marrow examination in such cases may result in inappropriate immunosuppressive treatment and delayed chemotherapy initiation. Published case reports of this presentation have collectively supported the recommendation to perform bone marrow biopsy in adult patients with unexplained thrombocytopenia unresponsive to standard ITP therapy, illustrating the direct clinical impact that well-documented case reports can achieve.

A.3, Unexpected Treatment Response: Venetoclax in Non-Canonical Indications

Venetoclax, a BCL-2 inhibitor approved for chronic lymphocytic leukemia and AML, has shown activity in a range of off-label hematological contexts including relapsed follicular lymphoma, mantle cell lymphoma, and certain myeloproliferative neoplasms. Case reports documenting these responses, with molecular correlates, response duration, and tolerability profiles, contribute directly to hypothesis generation for early-phase clinical trials and may accelerate regulatory consideration of label extensions.

A.4, Drug Toxicity: ICI-Associated Aplastic Anemia

Immune checkpoint inhibitor (ICI)-associated aplastic anemia is a rare but potentially fatal immune-related adverse event of PD-1 and CTLA-4 blockade. Before this complication was recognized in pharmacovigilance databases and oncology safety guidelines, it was characterized almost entirely through accumulating case reports and small case series. This example illustrates the pharmacovigilance function of case report literature and its direct translation into clinical guideline development.

A.5, Infectious Intersection: COVID-19-Associated Coagulopathy and VITT

The SARS-CoV-2 pandemic generated a wave of hematological case reports documenting novel clinical phenomena including COVID-19-associated coagulopathy, macro-thrombosis with thrombocytopenia, and vaccine-induced immune thrombocytopenia and thrombosis (VITT). Several of the earliest VITT case reports, published within weeks of vaccine rollout, directly informed emergency guidance from national and international hematology societies, demonstrating the public health function of timely case documentation.

A.6, Special Population: ITP in Pregnancy

The management of ITP in pregnancy requires balancing maternal platelet counts, fetal safety, and mode of delivery in a setting where randomized trial evidence is virtually absent. Case reports in this domain, describing corticosteroid response, intravenous immunoglobulin use, thrombopoietin receptor agonist safety, and neonatal outcomes, constitute the primary evidence base for clinical decision-making and will be actively sought by CHI:CR.

A.7, Diagnostic Challenge: NGS in Clonal Cytopenias of Undetermined Significance

Clonal cytopenias of undetermined significance, defined by somatic mutations (commonly TET2, DNMT3A, ASXL1, SF3B1) in the absence of a morphologically defined myeloid neoplasm, represent a diagnostic gray zone with significant prognostic and management implications. Case reports illustrating the clinical utility of next-generation sequencing (NGS) panels in resolving diagnostic ambiguity in such patients, including progression trajectories and therapeutic decisions, will be highly sought by CHI:CR as examples of precision diagnostics in clinical practice.