Hematologist

Blood is life itself, celebrated in myths, legends and poetic works. The human body contains about 5.5 liters of blood, each drop of which can bring either health or illness. The direction that studies the composition, diseases, and function of the hematopoietic system is called hematology, and a specialist directly involved in diagnostics and treatment of blood and bone marrow is a hematologist.

Who is a hematologist?

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

• Study of the etiology and pathogenesis of diseases of the hematopoietic 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 hematopoietic system.

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

A hematologist must have a basic higher medical education and complete courses in pathology and hematology. In addition, a hematology specialist must know:

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

Hematology as a medical field is closely related to related specializations – gynecology, oncology, surgery and others. Therefore, a hematologist can also specialize and be a pediatric hematologist, an oncohematologist, or a transplantologist.

When should you see a hematologist?

There are certain signs and symptoms that need to be monitored, as they may be a signal of serious hematological problems. The following manifestations may be a reason to contact a hematologist:

• Regular increase in body temperature, not associated with other diseases and visible objective reasons.
• Constant weakness, fatigue.
• Unexplained weight loss despite proper nutrition and daily routine.
• Excessive sweating.
• Cyanosis of the skin not associated with acute or chronic diseases of internal organs.
• Excessive redness of the face, persistent “crimson” hue.
• Gradual decrease in appetite.
• Fragility, brittleness of blood vessels, capillaries, constant formation of bruises.
• Regular tingling sensation in the fingers and toes.
• An increase or decrease in hemoglobin that goes beyond the normal range.
• Enlarged lymph nodes.
• Slow healing of scratches, wounds, bleeding.
• Chronic headache of unknown etiology.
• In case of chronic menstrual cycle disorders (joint consultation with the attending gynecologist).
• If viral or cold diseases are frequently diagnosed.
• A consultation with a hematologist is necessary for pregnant women.
• Planned conception of a child.
• A consultation with a hematologist is necessary for all residents of areas with elevated background radiation.

What tests should be taken when visiting a hematologist?

Before consulting a hematologist, it is necessary to follow the rules that help both the patient and the doctor to more accurately determine the cause of the disease and conduct analytical studies correctly. As a rule, the attending physician who writes out the referral indicates which tests need to be taken when contacting a hematologist, they can be as follows:

• OAC – complete blood count.
• Biochemical blood test.
• Blood test for RW.
• Blood test for HIV.
• Blood test for hepatitis.
• General urine analysis.

It is advisable to take additional tests:

• A coagulogram is an analysis that determines blood clotting; a hemostasiogram may be prescribed.
• Blood test for ferritin.
• Blood test for transferrin saturation level.

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

• Avoid eating for 10-12 hours before visiting a hematologist.
• Eliminate alcoholic beverages and smoking.
• If possible, avoid taking medication or notify the hematologist about taking the medication.
• Limit fluid intake for 24 hours.

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

What diagnostic methods does a hematologist use?

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

The first appointment begins with questioning the patient, examining the lymph nodes - neck, armpits, groin, elbows, knees, tonsils, spleen. Then, to determine the cause of the disease, the most informative is a comprehensive blood test, which determines the leukocyte formula, reticulocytes, platelets, etc. Often, clarifying information is provided by a myelogram - a bone marrow puncture and computed tomography. Ultrasound of the abdominal organs, lymph node biopsy, immunophenotyping, molecular tests (PCR), MRI, positron emission tomography may be prescribed.

List of standard examinations for patients with hematological diseases:

• Complete blood count and full blood count.
• Analysis for hemochromatosis - iron metabolism (TIBC - total iron-binding capacity of blood serum, transferrin, ferritin).
• An analysis that detects the forms of hemoglobin.
• An analysis that reveals pathology in the structure of red blood cells.
• Electrophoresis of protein fractions.
• Ultrasound examination of the abdominal organs.
• Ultrasound of peripheral lymph nodes.
• Chest X-ray.
• Computed tomography, MRI.
• Genetic research.
• Myelogram is a bone marrow puncture.
• Bone marrow trephine biopsy and histology.
• Biopsy and histology of lymph nodes.
• Immunophenotypogram.

What does a hematologist do?

The list of functions of a hematologist is extensive, this is due to the fact that clinical signs of blood diseases are not always specific and variable. Science has not studied many pathognomonic symptoms that indicate specific pathologies of the hematopoietic system. Therefore, the field of activity indicating what a hematologist does is conditionally divided into the following categories:

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

Organs that are in the area of attention, study, diagnosis and treatment by a hematologist:

• Blood:
  • Hematopoiesis.
  • Hemostasis – blood clotting, 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 a 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 what diseases a hematologist treats can be extensive, but here is a list of the main ones that are most often diagnosed:

• Anemia:
  • Aplastic anemia.
  • B12 deficiency anemia.
  • Hemolytic anemia.
  • Iron deficiency anemia.
  • Thalassemia.
  • Folate deficiency anemia.
  • Posthemorrhagic anemia.
  • Anemia caused by chronic pathologies.
• Leukemia.
• Hemoblastosis.
  • Acute leukemia:
    • Myeloid – myelomonoblastic, myeloblastic, monoblastic, promyelocytic leukemia.
    • Guglielmo's disease - erythromyelosis.
    • Lymphoblastic leukemia.
    • Megakaryoblastic leukemia.
  • Chronic leukemia:
    • myeloid chronic leukemia, lymphatic chronic leukemia.
• Lymphogranulomatosis.
• Lymphosarcoma

In addition, a hematologist treats autoimmune diseases – thrombocytopenia, increased bleeding, hemophilia.

Advice from a hematologist

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

Advice from a hematologist:

• It is necessary to undergo a hematological examination if there are persistent changes in the results of a clinical blood test (tests within two months).
• You should contact a hematologist if a blood test reveals an atypical hemoglobin level – elevated or decreased.
• A persistent change in the level of red blood cells, platelets, and white blood cells is a reason to undergo hematological diagnostics.
• Violation of ESR - slowing down or increasing speed.
• Any changes in the leukocyte count within a month.
• Splenomegaly is an increase in the size of the spleen.
• Enlargement of the liver of any etiology.
• Enlarged lymph nodes (within a month).
• Dermatitis, skin itching of unknown etiology.
• Constant formation of bruises and hematomas not associated with contusions or injuries.
• Constant nosebleeds.
• Long-term healing cuts, wounds, bleeding.
• Chronic menstrual irregularity with prolonged bleeding.
• Increased bleeding during dental procedures.
• A feverish condition of unknown etiology, without apparent cause.
• Thrombosis, PE – pulmonary embolism.
• History of myocardial infarction.
• Recurrent spontaneous miscarriages.
• Before 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 calling that requires a doctor to have extensive knowledge, master the latest diagnostic and treatment methods for such complex pathologies as diseases of the hematopoietic system. In addition to competence and responsibility, a hematologist is required to have a certain amount of courage and knowledge of psychology, because he faces human pain and fear every day. Obviously, those who truly correspond to the statement of Hippocrates go into this profession: “Everything that people seek for wisdom is in the art of healing - indifference to money, conscience, simplicity and modesty, respect for people, determination, cleanliness and tidiness, an abundance of knowledge and thoughts, as well as everything that is necessary to heal the patient”

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