Hematology

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Overview

Hematology (American English) or haematology (British English) is the branch of biology (physiology), pathology, clinical laboratory, internal medicine, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases. Hematology includes the study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases. The lab work that goes into the study of blood is performed by a Medical Technologist.

Blood diseases affect the production of blood and its components, such as blood cells, haemoglobin, blood proteins, the mechanism of coagulation, etc.

Hematologists and Hematopathologists

Physicians specialized in hematology are known as hematologists. Their routine work mainly includes the care and treatment of patients with hematological diseases, although some may also work at the hematology laboratory viewing blood films and bone marrow slides under the microscope, interpreting various hematological test results. In some institutions, hematologists also manage the hematology laboratory. Physicians who mainly work in hematology laboratories, and most commonly manage it, are pathologists specialized in the diagnosis of hematological diseases, referred to as hematopathologists. Hematologists and hematopathologists generally work in conjunction to formulate a diagnosis and deliver the most appropiate therapy if needed. Hematology is a distinct subspecialty of internal medicine, separate from but overlapping with the subspecialty of medical oncology. Hematologists may specialise further or have special interests, for example in:

treating bleeding disorders such as hemophilia and idiopathic thrombocytopenic purpura
treating hematological malignacies such as lymphoma and leukemia (onco hematology)
treating hemoglobinopathies
in the science of blood transfusion and the work of a blood bank

(Hema- comes from the Greek word "`'aima" meaning "blood", -logy comes from the Greek "logos" meaning word. [referring to the first root word, as in biology, with bio- meaning life and, of course

Common basic clinical hematology tests

In a clinical laboratory the hematology department performs numerous different tests on blood. The most commonly performed test is the complete blood count (CBC) also called full blood count (FBC), which includes; white blood cell count, platelet count, hemoglobin level and several parameters of red blood cells. Coagulation is a sub-speciality of hematology; basic general coagulation tests are the prothrombin time (PT) and partial thromboplastin time (PTT). Another common hematology test in the erythrocyte sedimentation rate (ESR).

In a blood bank the Coombs test is the most commonly performed test.

(Images shown below are courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan, and Hospital Universitario La Fe Servicio Hematologia)

Normal bone marrow
Normal bone marrow

Normal peripheral blood cells
Normal spleen

Monocyte TEM
Myeloblast

Neutrophil
Neutrophil and monocyte

Lymphocyte and erytrocyte
Lymphocytes and Thrombocytes

Neutrophil granulocytes
Neutrophil granulocytes
Neutrophil, basophil and active lymphocyte

Erythrocyte rouleaux formation
Erythrocyte rouleaux formation
Erytrocytes

Hematology as basic medical science

Classification of hematologic diseases

Hemoglobinopathies (congenital abnormality of the hemoglobin molecule or of the rate of hemoglobin synthesis)
Anemias (lack of red blood cells or hemoglobin)
- Iron deficiency anemia
- Megaloblastic anemia
  - Vitamin B₁₂ deficiency
    - Pernicious anemia
  - Folate deficiency
- Hemolytic anemias (destruction of red blood cells)
  - Genetic disorders of RBC membrane
    - Hereditary spherocytosis
    - Hereditary elliptocytosis
  - Genetic disorders of RBC metabolism
    - Glucose-6-phosphate dehydrogenase deficiency (G6PD)
    - Pyruvate kinase deficiency
  - Immune mediated hemolytic anaemia (direct Coombs test is positive)
    - Autoimmune hemolytic anemia
      - Warm antibody autoimmune hemolytic anemia
        Idiopathic
        
        Systemic lupus erythematosus (SLE)
        
        Evans' syndrome (antiplatelet antibodies and haemolytic antibodies)
      - Cold antibody autoimmune hemolytic anemia
        Idiopathic cold hemagglutinin syndrome
        
        Infectious mononucleosis
        
        Paroxysmal cold hemoglobinuria (rare)
    - Alloimmune hemolytic anemia
      - Hemolytic disease of the newborn (HDN)
        Rh disease (Rh D)
        
        ABO hemolytic disease of the newborn
        
        Anti-Kell hemolytic disease of the newborn
        
        Rhesus c hemolytic disease of the newborn
        
        Rhesus E hemolytic disease of the newborn
        
        Other blood group incompatibility (RhC, Rhe, Kid, Duffy, MN, P and others)
    - Drug induced immune mediated hemolytic anaemia
      - Penicillin (high dose)
      - Methyldopa
  - Hemoglobinopathies (where these is an unstable or crystalline hemoglobin)
  - Paroxysmal nocturnal hemoglobinuria (rare acquired clonal disorder of red blood cell surface proteins)
  - Direct physical damage to RBCs
    - Microangiopathic hemolytic anemia
    - Secondary to artificial heart valve(s)
- Aplastic anemia
Decreased numbers of cells
- Myelodysplastic syndrome
- Myelofibrosis
- Neutropenia (decrease in the number of neutrophils)
- Agranulocytosis
- Glanzmann's thrombasthenia
- Thrombocytopenia (decrease in the number of platelets)
  - Idiopathic thrombocytopenic purpura (ITP)
  - Thrombotic thrombocytopenic purpura (TTP)
  - Heparin-induced thrombocytopenia (HIT)
Myeloproliferative disorders (Increased numbers of cells)
- Polycythemia vera (increase in the number of cells in general)
- Leukocytosis (increase in the number of white blood cells)
- Thrombocytosis (increase in the number of platelets)
- Myeloproliferative disorder
Hematological malignancies
- Lymphomas
  - Hodgkin's disease
  - Non-Hodgkin's lymphoma{includes the next eight entries}
  - Burkitt's lymphoma
  - Anaplastic large cell lymphoma
  - Splenic marginal zone lymphoma
  - Hepatosplenic T-cell lymphoma
  - Angioimmunoblastic T-cell lymphoma (AILT)
- Myelomas
  - Multiple myeloma
  - Waldenström macroglobulinemia
- Plasmacytoma
- Leukemias
  - Acute lymphocytic leukemia (ALL)
  - Chronic lymphocytic leukemia (CLL){now included in theCLL/SCLL type NHL}
  - Acute myelogenous leukemia (AML)
  - Chronic myelogenous leukemia (CML)
  - T-cell prolymphocytic leukemia (T-PLL)
  - B-cell prolymphocytic leukemia (B-PLL)
  - Chronic neutrophilic leukemia (CNL)
  - Hairy cell leukemia (HCL)
  - T-cell large granular lymphocyte leukemia (T-LGL)
  - Aggressive NK-cell leukemia
Coagulopathies (disorders of bleeding and coagulation)
- Thrombocytosis
- Recurrent thrombosis
- Disseminated intravascular coagulation
- Disorders of clotting proteins
  - Hemophilia
    - Hemophilia A
    - Hemophilia B (also known as Christmas disease)
    - Hemophilia C
  - Von Willebrand disease
  - Disseminated intravascular coagulation
  - Protein S deficiency
  - Antiphospholipid syndrome
- Disorders of platelets
Miscellaneous
Hematological changes secondary to non-hematological disorders

Tests

Tests used in the investigation of hematological problems include:

Treatments

Treatments include:

Diet advice
Oral medication - tablets or liquid medicines
Anticoagulation therapy
Intramuscular injections (for example, Vitamin B12 injections)
Blood transfusion (for anemia)
Venesection (for iron overload or polycythemia)
Bone marrow transplant (for example, for leukemia)
Chemotherapy (for example, for leukemia)
Radiotherapy (in decline, for example, for leukemia)

External links

Additional Resources

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v t e Transfusion medicine
General concepts	Apheresis (plasmapheresis, plateletpheresis, leukapheresis) Blood transfusion Coombs test (direct and indirect) Cross-matching Exchange transfusion International Society of Blood Transfusion Intraoperative blood salvage ISBT 128 Transfusion reactions
Blood group systems / blood types	ABO Chido-Rodgers Colton Cromer Diego Dombrock Duffy Er FORS Gerbich GIL GLOB Hh Ii Indian JR JMH Kell (Xk) Kidd Knops Lan Lewis Lutheran LW MNS OK P Raph Rh and RHAG Scianna T-Tn Vel Xg Yt Other
Blood products / blood donation	Whole blood Platelets Red blood cells Plasma / Fresh frozen plasma / PF24 (Cryoprecipitate + Cryosupernatant) Blood substitutes