Hematology

What is Hematology? Who is Hematologist?

 

Blood diseases are in the scope of Internal Diseases (internal medicine) studies. In many countries and in Turkey as well, after two years of specialization in the field following four years of education in Internal Diseases, one is becoming hematology specialist or hematologist.

 

What is meant under Blood Diseases?

 

To provide an answer to this question first we need to roughly explain blood function and structure. Approximately 4-5 l of blood can be found in the body of a mature person. Blood is the liquid that has many functions: acts like a carrier of the substances necessary for organ nutrition or renewal of blood itself, with the help of substances called hormones allows organs to communicate, cleans body from the foreign matters and microbes, and reaches organs like lungs and kidneys to throw the harmful substances from the body. Blood contains minerals, nutrient factors, hormones, necessary proteins for reproduction and renewal of organ cells making it stay in the liquid form under normal conditions, proteins that enable blood clot in case of injury as well as toxic substances and cells created as a result of organs function.  There are 3 kinds of cells in the blood: red cells (erythrocyte), white blood cells (leukocyte) and blood-platelet (thrombocyte). These cells have following functions respectively oxygen and carbon dioxide transfer; protect body from microbes and harmful factors and enable coagulation in case of bleeding. Red blood cells contain molecules called hemoglobin that enables oxygen-carbon dioxide transport. Blood cells are made by bone marrow stem cells and after a certain time they break down. Marrow is constantly producing blood cells so their numbers remain stable in certain limits. Lymph, thymus gland and spleen, in collaboration with white blood cells, are working on protecting the body from microbes and harmful factors (immune system). Lymph glands, one kind of white blood cells called lymphocytes, are small organs produced to fight against microbes. Thymus gland has the similar function.

 

There are some major groups of diseases that are in the scope of hematology science, summarized as follows:

 

- Disruption of blood cell or hemoglobin production in marrow (different anemia – leucopenia and thrombocytopenia).

- Acceleration of blood cells breaking (hemolytic anemia, ITP and similar)

- Disruption of blood cell functions (sickle-cell anemia, different function disorders, etc.)

- Disruption of blood coagulation (hemophilia, von Willebrand disease, etc.)

- Blood coagulation in redundant places inside vascular system (thromboses, pulmonary thromboembolism, thrombophlebitis, etc.)

- Blood marrow stem cells and lymph cells cancers (leukemia, lymphomas, miyelom, etc)

 

What are the symptoms of blood diseases?

 

Some of the main symptoms that can be connected with blood diseases are: weakness, paleness, quickly getting tired, often suffering from infections, fever that cannot be returned into normal, sudden bleeding or bleeding as a result of slight trauma, long bleeding after injury, growing painless swellings (gland) on the neck, under arm or on groin or sudden painful edema (enlargement) of the whole leg or under knee.

 

What are the main methods used in the diagnosis of blood disease?

 

In diagnosing blood diseases there may be a need for many different kind of tests: measurement of blood cells and hemoglobin quantity (complete blood count), hemoglobin subtypes analysis with electrophoresis, blood examination under microscope (peripheral smear), bone marrow examination (bone marrow aspiration and biopsy),iron necessary for blood production, vitamin B12 and examination of folic acid levels, exploring blood coagulation, tests related to blood cell functioning and life cycle, examining proteins for producing immune system cells, radiological examinations and analysis of blood cells and chromosome of bone marrow stem cells, and examinations of other elements of blood structure are some of the most needed tests.

 

What is anemia? Why is iron deficiency occurring?

 

Anemia is the volume decrease of hemoglobin, molecule found in red blood cells with the function of transporting oxygen. There are many reasons why anemia occurs. Iron deficiency is one of the most often ones. Iron is necessary for the production of hemoglobin molecule. Deficiency of this mineral can be due to small intake of iron in nutrition or because of obvious or invisible bleeding which causes increase of iron loss from the body. This deficiency is main cause for anemia. Anemia is the reason for complaints and symptoms like weakness, paleness and quickly getting tired. Iron deficiency is mostly seen with young women, in adolescence period or undernourished babies.

 

What is Mediterranean Anemia (Thalassemia)? What is the importance of this disease on patient?

 

Mediterranean anemia is the genetic (hereditary) disease with hemoglobin molecule productivity disruption since birth. Patients with beta-thalassemia diseases can often be seen in Turkey (or any other country of Mediterranean region). Besides light anemia there is no any other problem for the patient. In addition, there is 25% risk that the sick baby will be born from mothers and fathers with this disease. In some of the south provinces of Turkey it is obligatory to take examinations for the carriers of this disease.

 

What is Leukemia? Can it be treated?

 

Leukemia is a disease known as the blood cancer or marrow cancer. Cells in the bone marrow, responsible for blood production, become cancerous which results in their further development. In fact is not a single disease, but instead it has a various different types. Cancerous marrow blood cells do not produce the health one; they also invade the bone marrow not leaving the place for the cells to produce healthy blood. Leukemia can be roughly divided into two groups: the acute and chronic. When it is not treated, acute leukemia often leads to death within weeks or months. A large part of these patients can be under medicine treatment called chemotherapy or can be cured with a bone marrow transplantation (stem cell transplantation).On the other hand, chronic leukemia patients, if left to run on their own, often can live with it for years (and sometimes decades). It is more difficult to treat patients with chronic leukemia with medicines. With these patients in general, medicine treatment and support do not lead to complete recovery, but it can be seen more as improving the life quality and prolonging the life period. Some types of chronic leukemia can be cured by stem cell transplantation.

 

What are the primary methods used in the diagnosis of blood diseases?

 

To diagnose blood diseases it may be needed to refer to many different tests: measuring the amount of blood cells and hemoglobin (complete blood count ), analysis of hemoglobin sub-species with electrophoresis, a blood test under the microscope ( the peripheral spread), examination of the bone marrow (bone marrow aspiration and biopsy), iron necessary for the blood formation, to investigate the levels of vitamin B12 and folic acid , screening coagulation, tests related to blood cells functions and life duration, examining the proteins produced by the immune system cells, tests regarding examination of blood cells´ or bone marrow cells´ chromosomes and other constructive elements, and lots of other necessary radiological examinations.

 

When is blood transfusion (transplantation) done? Can blood donation be harmful?

 

Blood is a very valuable substance for medical treatments which cannot be produced in scientific environment and because of this it can be collected only from the human volunteer donors. If it is used properly it can save lives and if not, it can cause serious health problems. For this reason, the same as it is social responsibility for health individuals to donate blood; in the same way it is doctors´ responsibility to properly and carefully use this blood. People who wish to donate blood should pass through carefully prepared health examination. For health blood donors there are no any negative effects except the reaction caused by fear and worry. Blood product transfusions may be required in cases of severe bleeding, with anemia that can put patient´s life into risk or spoil the quality of life and in certain period will not show reaction to the adequate medicine treatment, drop of blood-platelet (thrombocyte) to dangerous levels, in case of bleeding with persons whose blood-platelet or coagulation protein in blood decreases or when the bleeding is expected. Generally, except in cases of severe bleeding, complete blood transplantation is not being performed. Instead, transplantation of only the missing components in the body is preferred.

 

What are bone marrow aspiration and biopsy and how it is done?

 

Marrow is an organ that produces blood cells (red cells, white cells and blood-platelet). There are also main cells that produce blood cells in bone marrow. Examination of number, structure and function of these cells and obtaining necessary information about them is called bone marrow aspiration and biopsy. With these kinds of blood tests, blood disease, which cannot be registered with other examinations (like radiological one), can be diagnosed and treated.

 

  1. At the appointed time, you will come with the bone marrow needle for which prescription will be given to you earlier. Sometimes your doctor may prefer to use needles which can be found in his/her office or hospital, which can be used several times and which are sterilized on high temperature. In these situations doctor will not give you the prescription for needles.   
  2. For the treatment you do not have to come with empty stomach. Marrow samples are taken from front or back of the hip bone (= iliac bone) or from the vertical bone in the middle of the breast area (= sternum). For example, you will be asked to take the appropriate position and take off your clothes from the body area that will be used to take the sample. This sample is often taken from the back of the hip bone. You will be asked to lay in face down position or by laying on the left or right side you should pull leg towards your stomach.
  3. Skin area from where the marrow sample will be taken should be carefully cleaned with skin batticon or other similar local antiseptics or alcohol. After being thoroughly cleaned, skin, subcutaneous tissue and the membrane covering the bone is anesthetized by a local anesthetic drug needle. The pain caused by this anesthetics drug needle is not different than the one from any other injections done in the hip area.
  4. After achieving numbness (= anesthesia) marrow needle is injected and bone marrow (with slightly more dense consistency than blood) is taken with the help of injector mounted at the back of the marrow needle. Obtained sample is taken to the laboratory in the injector, on small glasses called lamina or inside small tubes. Inserting marrow needle will not make too much pain. However, when marrow sample is pulled by the injector a short-term pain spread towards the leg can be felt. Doctor will warn you about this short pain so that you can get prepared for it.
  5. Above explained procedure is called aspiration. Your doctor will sometimes want to do the biopsy together with the aspiration. Biopsy is procedure done after the aspiration and is generally taken from the same area. In this procedure very small piece of bone should be pulled out with the marrow needle. During biopsy, patient can feel a short pain.
  6. All these procedures will last for about 15-20 minutes. After finishing, injected place is closed by dressing the wound. According to the recommendation from doctor that performed the procedure, you will be allowed to stand up immediately or after a short rest.
  7. Medical dressing from the wound can be removed after 24-48 hours. During this period, this dressing is not supposed to get wet so you should be careful when taking a bath.
  8. After the effect of anesthetic medicine passes, in injected area patient can feel light pain. Walking can ease the pain. If needed, after consulting doctor, every 4-6 hours patient may use pain-killer medicine called paracetamol (minoset, parole, etc.).