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Clinical Haematology: Blood Doctor in the House

Clinical Haematology is a sub speciality in Internal Medicine, dealing with blood diseases.  The blood, otherwise known as the haematopoietic system consists of:

  • Red cells (Erythrocytes)
  • White cells (Leukocytes)
  • Platelets
  • Plasma
  • Coagulation factors
  • Lymphatic system (Lymph nodes)


The Haematopoietic System


What is the role of a Clinical Haematologist?

A Clinical Haematologist is the most qualified person to treat blood diseases.  These are generally divided into

  • General Haematology
  • Blood Cancers (Haematological Malignancies or Haemato-oncology)

  What kind of problems are seen in General Haematology?

The most common problems seen in General Haematology are Anaemia (low Haemoglobin), Thrombocytopenia (low platelets) or abnormal blood counts.  These could be primary diseases on their own, but also could be early signs for blood cancers or other medical conditions. The common diseases seen are

  • Nutritional Anaemia (Iron, B12 and Folate deficiencies)
  • Haemolytic Anaemia
  • Thalassaemia and Haemoglobin disorders
  • Aplastic Anaemia
  • Immune Thrombocytopenia

Other types of problems are bleeding and clotting disorders.  They include diseases such as

  • Deep Vein Thrombosis
  • Venous and Arterial Thromboembolism
  • Haemophilia
  • Antiphospholipid Syndrome
  • Thrombotic disorders/Thrombophilia

 What are Blood Cancers?

Each cellular component of the blood including the lymph nodes may develop cancer.  The more commonly known blood cancers are

  • Leukemia (Cancer of the white cells)
  • Lymphoma (Cancer of the lymph node tissues)
  • Multiple Myeloma (Cancer of the plasma cells, a type of white cell)

Other types of blood cancers seen are

  • Myeloproliferative neoplasm (Proliferation of red cell, white cell and platelet precursors).  Common conditions are Polycythaemia Rubra Vera, Essential Thrombocythaemia and Primary Myelofibrosis
  • Myelodysplastic syndrome (“Dysfunctional” blood cells, which may lead to leukemia)

 How Are Blood Cancers Diagnosed and Staged?

Blood Cancers are diagnosed many ways.  Leukemia for instance are generally detected from Full blood picture and confirmed by Bone Marrow Aspiration and Trephine Biopsy.  Lymphoma are diagnosed from the tissue biopsies.

Staging are done in various ways.  Blood and bone marrow examination, cytogenetics, molecular testing and specific biochemical tests can be performed to stage blood cancers.   Other methods of staging include CT scan, MRI and PET scans.

How Are Blood Cancers Treated?

Blood Cancers are generally treated with chemotherapy.  However the treatment of cancer has grown in leaps and bounds with the development of Immunotherapy and Targeted Therapies.  They can be used alongside conventional chemotherapy or on their own.  These state of the art treatments has improved cure rates tremendously and even led to paradigm shifts in the treatment of blood cancers.

Another established approach to treat blood cancers is by performing Bone Marrow Transplant.

What is Bone Marrow Transplant?

Bone Marrow Transplant, otherwise known as Haematopoietic Stem Cell Transplant (HSCT) is the process of infusing a patient’s own (autologous) or donor’s (allogenic) blood stem cells.  The stem cells are infused after the patient is “conditioned”.

Some types of blood cancers require bone marrow transplant to improve outcomes and prolong survival.


A Patient undergoing Haematopoietic Stem Cell Transplant/Bone Marrow Transplant from Allogenic sources (Donor)

 

What are the services provided by a Clinical Haematologist?

The primary diagnostic service provided by a Clinical Haematologist is to perform Bone Marrow Aspirate and Trephine Biopsy.



Bone Marrow Aspiration and Trephine Biopsy

A Clinical Haematologist works closely with the laboratory to ensure close clinical correlation and acquire the accurate diagnosis for all types of blood disorders.  They are also able to make accurate and immediate interpretation of specific Haematological investigations so that prompt treatment and management can be given.

The treatment of the blood cancers will be guided and administered by the Clinical Haematologist with the support of Haemato-oncology trained nurses and staff.

They provide consultation services to the other specialties with regards to any blood diseases.

Another important role of a Clinical Haematologist is to lead transfusion services.  An approach known as “Patient Blood Management” has reduced unnecessary transfusions of blood products and improved the safety in transfusion practices.

Monday, 22 April 2019 by Dr Tengku Hidayat (Haematology & Internal Medicine)

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