Specialties +

Clinical Haematology is a branch of clinical medicine, dealing with diagnosis and treatment of blood disorders and blood cancers.

Which patients should visit a Clinical Haematologist and meet the haematology specialist?

Patients who have an abnormality in their CBC report. For instance,

• Low/ High Haemoglobin (Hb) value
• Low/ High WBC counts
• Low/ High platelet counts

Which patients can benefit from Haematologist and Hemato-oncologist's (Blood & Blood Cancer specialist) expertise?

• Weakness/loss of energy ( Anaemia)
• Bleeding/purpura (Thrombocytopenia)
• Repeated infections/boils (Neutropenia)
• Pancytopenia (combination of above) in aplastic anaemia, Leukaemia.
• Swollen leg ( Deep Venous Thrombosis - DVT)
• Weight loss/ loss of appetite ( Blood cancer, Leukaemia)
• Bone pain/ bone fracture ( Multiple Myeloma)
• Lymphadenopathy ( Lymphoma,/ Hodgkin's Lymphoma)
• Splenomegaly (CML, Lymphoma, Myelofibrosis, infections, fever)
• Joint bleeding/ rare site of bleeding (Haemophilia)
• Excessive menstrual bleeding (No obvious Gynaec.cause)
• Increased haemoglobin ( Polycythaemia)
• Excessive platelet count ( Thrombocytosis)
• Excessive WBC count ( Chronic Leukaemia like CLL)
• Excessive eosinophil count (Eosinophilia)
• Warfarin monitoring with INR & adice on thrombophilia screening.
• Pyrexia of unknown origin (fever for 1-2 weeks and not responding)
• Thalassemia/ sickle cell anaemia.
• Blood Transfusion problems
• Pregnancy related haematology problem/DIC.
• Patients who need Blood Transfusions.

Anaemia: Anaemia is a sign where there is a reduced level of the haemoglobin and red cells in the blood. It is not a disease by itself but is a manifestation of another condition which can as simple as nutritional deficiency of iron to bowel cancer or blood cancer. Blood cells are made by your bone marrow, which is a spongy substance in the centre of your bones. There is a constant process of production of new blood cells and the destruction of blood cells happening all the time. The balance between these processes is maintained such that the haemoglobin and other blood cells are kept in the normal range.

Thrombocytopenia: Platelets are one of the cells in the blood and are produced in the bone marrow where lies the factory of blood. Blood is composed of two components, plasma (fluid component) and cells (cellular component). There are three types of cells in blood, red blood cells, white blood cells and platelets. A normal human platelet count ranges from 150,000 to 450,000 platelets per microlitre of blood. Often, low platelet levels do not lead to clinical problems; rather, they are picked up on a routine complete blood count (CBC). Occasionally, there may be bluish reddish patches on the skin (bruising), pin point bleeding on the skin, nosebleeds and/or bleeding gums. It is vital that to ensure that the low platelet count is not associated with reduction in other blood cells like red blood cells and white blood cells. Also the acute secondary causes like malaria, dengue etc. must be ruled out. Three common causes of low platelet counts are: Reduced production of platelets from the bone marrow because of reduced function of the bone marrow, infiltration of bone marrow by cancer cells, drug and medicine toxicity or vitamin deficiency like B12 and folate deficiency etc. Increased utilisation of the platelets is seen in cases of infections, abscess etc. Increased destruction of the platelets is seen in cases of antibody related destruction of the platelets e.g. ITP

Aplastic anaemia: Aplastic anaemia is a condition where bone marrow does not produce sufficient new cells to replenish blood cells. Aplastic anaemia patients have lower counts of all three blood cell types: red blood cells, white blood cells, and platelets, termed pancytopenia. In many cases, aetiology is considered to be idiopathic (without a known cause), but one known causes are immune disorders, viral infections like parvovirus infections, drugs and toxins. Bone marrow examination and several blood tests for the cause of pancytopenia are necessary before starting treatment for aplastic anaemia. Bone marrow transplant is currently the best treatment for aplastic anaemia.

Myelodysplastic syndrome (MDS): The myelodysplastic syndrome is a preleukaemic condition leading to ineffective production of blood cells and production of abnormally looking and functioning blood cells. Patients with MDS often develop severe anaemia and require frequent blood transfusions. In most cases, the disease worsens and the patient develops cytopenias (low blood counts) caused by progressive bone marrow failure. In about 20% of patients MDS transforms into acute leukaemia (AML), usually within months to a few years. There are ways on the blood and bone marrow tests to predict which patients with MDS are likely to transform into acute leukaemia. The myelodysplastic syndromes are all disorders of the stem cell in the bone marrow. In case of young fit patients the treatment of choice is bone marrow transplantation. In case of patients who are not fit enough, injection treatments are available to improve the bone marrow function.

Sickle cell disease: Sickle-cell disease (SCD) or sickle-cell anaemia is a genetic blood disorder characterized by red blood cells that assume an abnormal, rigid, sickle shape. This shape is less flexible and results in a risk of various complications. The sickling occurs because of a mutation in the haemoglobin gene. Sickle-cell disease is the name of a specific form of sickle-cell disorder where both the genes are abnormal leading to lack of normal haemoglobin production. This is also referred to as sickle-cell anaemia. People carrying only one gene and one normal adult haemoglobin gene, it is referred to as "sickle cell trait". The manifestations of sickle cell trait are very mild and the life expectancy of such people is normal. There are treatments like recurrent blood transfusion to suppress abnormal blood production, medications like hydroxyurea to reduce and prevent complications, medicines to prevent infections has prolonged the life of patients with sickle cell disease. The best therapy currently for sickle cell disease is bone marrow transplantation in suitable patients.

Leukaemia: Leukaemia is a type of cancer of the blood or bone marrow. There are several types of Leukaemia. There are two common varieties of leukaemias acute and chronic. If untreated acute Leukaemia can be life threatening in matter of hours to days. Chronic leukaemias progress very slowly. Both types of Leukaemia's lead to bone marrow failure because of abnormal cells occupying the space in the marrow leading to reduced production of the normal cells. Blood tests and the bone marrow examination are done for diagnosis and predicting the prognosis of Leukaemia. Several genetic and molecular tests are now done to predict the prognosis and need to bone marrow transplantation to avoid the leukaemia from coming back after treatment.

Lymphoma: Lymphoma is a cancer of the lymphocytes, a type of cell that forms part of the immune system. Typically, lymphoma is present as a solid tumour of lymphoid cells. There are several hypes of lymphoma. The cancer cells often originate in lymph nodes, presenting as an enlargement of the node (a tumour). It can also affect other organs like skin, brain, bowels and bone. Two common types are high grade lymphomas and low grade lymphomas. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation and can be curable depending on the histology, type, and stage of the lymphoma.

Myeloma: Multiple myeloma also known as plasma cell myeloma is a cancer of plasma cells, a type of white blood cell present in the bone marrow and normally contribute in the immune function. In multiple myeloma plasma cells accumulate in the bone marrow leading to reduced production of normal blood cells. Most cases of myeloma also have abnormal protein in blood called paraprotein. Cancerous plasma cells and the Paraprotein lead to bone lesions, high calcium and kidney problems. In fact kidney failure can be a presentation of myeloma. Myeloma is diagnosed with blood tests (serum protein electrophoresis, serum free kappa/lambda light chain assay), bone marrow examination, urine tests and X-rays of bones. Myeloma is generally thought to be treatable but incurable. Treatment is in the form of chemotherapy, immunomodulatory medicines and stem cell transplants. Radiation therapy is sometimes used to reduce pain from bone lesions.