Hematologist

Blood is life itself, sung in myths, legends and poetic creations. In the human body contains about 5.5 liters of blood each drop of which can carry either health or disease. The direction that studies the composition, diseases, the function of the hematopoietic system is called hematology, and the specialist who directly deals with the diagnosis, treatment of blood and bone marrow is a hematologist.

[1], [2], [3]

Who is a hematologist?

Hematology is a rather rare medical specialization, the main tasks of which are: 

• Study of the etiology and pathogenesis of diseases of the hematopoiesis system.
• Study of clinical signs of blood pathology.
• Development and implementation of methods for diagnosing blood and bone marrow diseases.
• Treatment and prevention of pathologies of the hematopoiesis system.

Many patients are not aware of who the hematologist is, so we offer a brief description of this important and extremely topical specialization in our time.

The hematologist must have a basic higher medical education and take courses in pathology and hematology. In addition, a specialist in the field of hematology should know: 

• Embryogenesis, morphology and physiology of cellular elements of blood and organs of the hematopoiesis system.
• Characteristics and properties of plasma, serum.
• Properties of the hematopoiesis system, both in pathological blood diseases, and in non-hematological diseases.
• Properties of blood under the influence of ionizing radiation (radiation hematology).
• Fundamentals of hemostasiology.
• Fundamentals of immunohematology.
• Fundamentals of oncohematology.
• Diagnostic methods for determining pathologies of blood and bone marrow - puncture, trepanobiopsy, biopsy of lymph nodes, liver, biochemical, radioimmunological, radiological, cytological, immunological methods.
• Methods of chemotherapy.
• System of medical examination.
• Basic principles of medical ethics (deontology).

Hematology as a medical direction is closely related to related specializations - gynecology, oncology, surgery and others. Therefore, the hematologist can also specialize and be a pediatric hematologist, oncohematologist, transplantologist.

When should I go to a hematologist?

There are certain signs, symptoms, which need to be monitored, since they can be a signal of serious hematologic problems. The reason for applying to a hematologist can be such manifestations: 

• Regular increase in body temperature, unrelated to other diseases and visible objective reasons.
• Constant weakness, fatigue.
• Unexplained weight loss with full nutrition and day regimen.
• Excessive sweating.
• Cyanosis of the skin, unrelated to acute or chronic diseases of internal organs.
• Excessive redness of the face, stable "scarlet" shade.
• Gradual decrease in appetite.
• Friability, fragility of blood vessels, capillaries, permanent bruising.
• Regular tingling sensation in the fingers and toes.
• Increase or decrease of hemoglobin, exceeding the limits of the norm.
• Enlargement of lymph nodes.
• Slow healing of scratches, wounds, bleeding.
• Chronic headache of unclear etiology.
• With chronic violation of the menstrual cycle (joint consultation with the treating gynecologist).
• If viral or colds are often diagnosed.
• Hematology consultation is necessary for pregnant women.
• Planned conception of the child.
• Consultation of a hematologist is necessary for all residents of areas with an increased radioactive background.

What tests should I take when I visit a hematologist?

Before consulting a hematologist, it is necessary to follow the rules that help both the patient and the doctor to determine the cause of the disease more accurately, and to conduct analytical studies competently. As a rule, the attending physician who prescribes the direction, indicates which tests to pass when addressing a hematologist, they can be: 

• UAC is a general blood test.
• Blood chemistry.
• Blood test for RW.
• Blood test for HIV.
• Blood test for hepatitis.
• General urine analysis.

It is advisable to take additional tests: 

• Coagulogram - an analysis that determines the coagulability of blood, it is possible to appoint a hemostasiogram.
• Blood test for ferritin.
• Blood test for transferrin saturation.

The hematologist also prescribes many types of blood tests that can be performed on the day of the doctor's visit, so the patient is required to follow such recommendations: 

• Exclude food intake for 10-12 hours before going to the hematologist.
• Exclude alcoholic beverages and smoking.
• If possible, exclude the taking of medication or warn the hematologist about taking the medication.
• Within 24 hours, restrict fluid intake.

Of course, a visit to the hematologist assumes the presence of an outpatient card or an extract from the medical history, the directions of the attending physician, as well as the results of previous studies, both laboratory and instrumental.

What methods of diagnosis does the hematologist use?

Diagnosis of hematological diseases includes clinical, instrumental, laboratory and genetic methods of research.

The first reception begins with the patient's interview, examination of the lymph nodes - neck, zone of armpits, groin, elbows, knee, tonsils, spleen. Further, to determine the cause of the disease, the most detailed blood test, which determines the leukocyte formula, reticulocytes, platelets and so on, is the most informative. Often refining information gives a myelogram - bone marrow puncture and computed tomography. Ultrasound of the abdominal organs, lymph node biopsy, immunophenotyping, molecular tests (PCR), MRI, positron emission tomography can be prescribed.

List of standard examinations of patients with hematological diseases: 

• UAC and a detailed blood test.
• Analysis for hemochromatosis - the exchange of iron (OZHS - total iron binding ability of blood serum, transferrin, ferritin).
• An analysis that identifies hemoglobin forms.
• Analysis, revealing the pathology of the structure of erythrocytes.
• Electrophoresis of protein fractions.
• Ultrasound examination of the state of the abdominal cavity organs.
• Ultrasound of peripheral lymph nodes.
• Chest X-ray.
• Computed tomography, MRI.
• Genetic studies.
• Myelogram - a puncture of the bone marrow.
• Trepanobiopsy of bone marrow and histology.
• Biopsy and histology of lymph nodes.
• Immunophenotypinggram.

What does the hematologist do?

The list of functions of the hematologist is voluminous, this is due to the fact that the clinical signs of blood diseases are not always specific and variable. Science has studied not so many pathognomonic symptoms that indicate specific pathologies of the hematopoiesis system. Therefore, the scope of activity, which indicates what the hematologist does, is conditionally divided into the following categories: 

1. General hematological practice, which includes the diagnosis and treatment of anemia, leukopenia, pancytopenia, that is, diseases that are not related to the division of oncological pathologies.
2. Oncohematology - the intersection of hematology and oncology, that is, diagnosis and treatment of malignant pathologies of the hematopoiesis system (myeloleukemias, leukemias and others) 3.
3. Theoretical hematology is a research activity related to the properties of hematopoiesis processes, as well as molecular genetics, blood transfusion techniques, organization of donor blood banks, bone marrow transplantation, stem cells

The organs that are in the zone of attention, study, diagnosis and treatment by the hematologist: 

• Blood: 
  • Hemopoiesis.
  • Hemostasis - coagulability of blood, coagulopathy.
  • Venous blood, including puncture.
  • Clinical blood test.
  • Blood from the umbilical cord.
  • Red, white blood cells.
  • Platelets.
  • Blood groups.
• Bone marrow.
• Spleen.

What diseases does the hematologist treat?

According to statistics, blood diseases account for 7.5 to 9% of the total number of human diseases. Hematology includes 2 large groups of blood diseases - anemia and leukemia

The list of pathologies, describing which diseases the hematologist treats, can be extensive, we will list the main, most often diagnosed: 

• Anemia: 
  • Aplastic anemia.
  • B12-deficiency anemia.
  • Hemolytic anemia.
  • Iron-deficiency anemia.
  • Thalassemia.
  • Folic deficiency anemia.
  • Posthemorrhagic anemia.
  • Anemia caused by chronic pathologies.
• Leukemia.
• Hemoblastosis.
  • Acute leukemia:
    • Myeloid - myelomonoblast, myeloblast, monoblast, promyelocytic leukemia.
    • Guglielmo disease - erythromyelosis.
    • Lymphoblastic leukemia.
    • Megacaroblastic leukemia.
  • Chronic leukemia:
    • myeloid chronic leukemia, lymphatic chronic leukemia.
• Lymphogranulomatosis.
• Lymphosarcoma

In addition, the hematologist treats autoimmune diseases - thrombocytopenia, increased hemorrhage, hemophilia.

Advices of a hematologist

Hematological disorders, diseases are considered one of the most dangerous, Preventing blood diseases is difficult, but there are symptoms that should alert a person and force him to consult a doctor. Early diagnosis and timely treatment significantly increases the survival rate or prolongs the period of remission, and some blood diseases can be neutralized completely.

Advices for a hematologist: 

• A hematological examination is necessary if there are persistent changes in the results of a clinical blood test (analyzes within two months).
• You need to consult a hematologist if the blood test reveals an atypical level of hemoglobin - increased or decreased.
• A persistent change in the level of erythrocytes, platelets, and leukocytes is an occasion to undergo hematological diagnostics.
• Violation of ESR - slowing or increasing speed.
• Any changes in the leukocyte formula within a month.
• Splenomegaly - an increase in the size of the spleen.
• Increased liver size of any etiology.
• Enlarged lymph nodes (within a month).
• Dermatitis, itchy skin of unclear etiology.
• Permanent bruising, bruising, not associated with bruises, injuries.
• Constant nosebleeds.
• Long-lasting healing cuts, wounds, bleeding.
• Chronic disorder of the menstrual cycle with prolonged bleeding.
• Increased bleeding during dental manipulation.
• A feverish state of unclear etiology, for no apparent reason.
• Thrombosis, PE - thromboembolism of the pulmonary artery.
• Myocardial infarction in the anamnesis.
• Recurrent spontaneous miscarriages.
• Before carrying out hormone replacement therapy.

According to WHO statistics, the percentage of diagnosed blood diseases is steadily increasing every year, so preventive examinations and early diagnosis are extremely important and relevant.

A hematologist is not just a specialization, but a vocation that requires extensive knowledge from the doctor, possession of the latest diagnostic and therapeutic techniques for such complex pathologies as diseases of the hematopoiesis system. In addition to competence and responsibility from the hematologist requires a certain amount of courage and knowledge of psychology, because every day he faces human pain, fear. In this profession, obviously, those who really correspond to the statement of Hippocrates go: "All that people seek for wisdom is in the art of healing - indifference to money, conscience, simplicity and modesty, respect for man, determination, cleanliness and neatness, abundance knowledge and thoughts, as well as all that is necessary for the healing of the patient "

[4], [5], [6]