The layman usually thinks of blood simply as a red liquid. However, this body fluid is actually an extremely complex mixture of liquid, dissolved and cellular components.
Oxygen-rich blood is transported from the heart to every organ and tissue via the blood vessels. There it supplies the body's cells with nutrients and oxygen, and on its return journey it carries carbon dioxide to the lungs, where the carbon is removed from the body by exhalation. Blood also transports metabolic products to other organs, such as the liver, where they are processed further or broken down so that they can be excreted, particularly via the kidneys.
Due to these outstanding properties, blood could therefore be described as a fluid tissue that - like any other organ - can become diseased.
Benign blood diseases include, in particular, a lack of platelets or white blood cells as well as various types ofanemia, Wilson's disease or hemochromatosis. Wilson's disease is better known as copper storage disease, haemochromatosis as iron storage disease, and delayed blood clotting can also have physical causes that need to be clarified.
In haematology, malignant blood diseases include the following, for example:
- Acute and chronic leukemias: Blood cancer that originates from bone marrow cells
- Myelodysplastic syndromes: stem cell disease of the haematopoietic system (bone marrow disease)
- Malignant lymphomas: cancers of the lymphatic system ("lymph gland cancer")
- Multiple myeloma: malignant proliferation of antibody-forming blood cells
- Myeloproliferative diseases: also a stem cell disease of the hematopoietic system (bone marrow disease)
As with every medical examination, the doctor will start by asking about your medical history, any medication you are taking and any current complaints(anamnesis). During the physical examination, abnormalities such as changes in the color of the skin and mucous membranes as well as swollen lymph nodes in the neck, armpits and groin are checked for. Enlarged lymph nodes are assessed according to their texture, pain and ability to move.
If there are indications of a blood disorder, the other organs, for example the spleen and liver, are also palpated and, if necessary, examined more closely using ultrasound (sonography).
A very important element of haematological diagnostics is the detailed examination of the blood count, which can be used to determine the composition of the blood. Thus
- the blood cells (red blood cells = erythrocytes, white blood cells = leukocytes, platelets = thrombocytes) are counted,
- the ratio of the cells to each other and the different types of leukocytes are determined,
- assess the appearance of the blood cells and
- some important hemoglobin (Hb) and erythrocyte parameters are measured, such as the Hb value and the MCV value (mean cell volume).
The haematologist can already identify diseases from the blood count and may even be able to assess how advanced the disease is.
During the bone marrow examination, bone marrow is removed from the patient(bone marrow puncture), stained and then examined microscopically(cytomorphology). This sometimes allows more precise conclusions to be drawn about blood formation and possible blood diseases.
There are also other special examinations, such as
- Flow cytometry (more precise characterization of cells),
- cytogenetics (examination of chromosomal changes),
- molecular genetics (genetic examinations) and
- histopathology (examination of tissue samples),
which help to make the correct diagnosis.
The hematologist may also need to remove a lymph node and examine it in detail to confirm or rule out a suspected lymph node cancer.
If there is a suspicion that blood cancer cells have spread to other organs or that there is damage to them, further examinations are required. These may include imaging examinations(X-ray, CT, MRI, ultrasound), ECG (electrocardiography) or lumbar puncture (examination of cerebrospinal fluid).
The therapeutic concepts are as varied as the blood disorders themselves. In the case of malignant blood disorders in particular, it is important that the haematologist chooses a treatment concept that is tailored to the individual patient in the best possible way.
Chemotherapy is one of the classic forms of treatment for cancer, but it can be associated with considerable side effects. A stem cell transplant may be necessary, which is also carried out by a hematologist. If a malignant blood disease cannot be cured, the focus is on so-called palliative or supportive concepts, which are intended to alleviate symptoms and avoid complications.
In the case of benign blood disorders such as anaemia, however, it is often sufficient to give the patient a blood transfusion with blood from a donor. However, drug therapies can also be part of the treatment strategy.
Haematologists often have a specialist qualification in internal medicine and haematology and oncology (haematologist and oncologist). This specialist training can be undertaken by a doctor licensed in Germany after completing a medical degree. This requires six years of practice - three years in internal medicine and three years in hematology and oncology - during which a specified number of diagnostic procedures and therapies must be carried out.
This gives the hematology expert in-depth knowledge in all areas of the diagnosis and treatment of hematological diseases.
