Hematology: Diagnosis, Treatment, and Interesting Facts

To the layperson, blood is generally seen as a red liquid. In fact, this bodily fluid is an extremely complex mixture of liquid, dissolved, and cellular components.

Blood vessels transport oxygen-rich blood from the heart to every organ and tissue. There, it supplies the body’s cells with nutrients and oxygen. On its return journey, it carries carbon dioxide to the lungs, where it is expelled from the body through exhalation.

Blood carries metabolic waste products to other organs, such as the liver. The liver processes or breaks them down. The kidneys then excrete them.

Because of these remarkable properties, blood could be described as a liquid tissue that is also susceptible to disease.

The circulatory system supplies all the body’s cells with nutrients and oxygen @ Avanne Troar /AdobeStock

Benign blood disorders are characterized in particular by the following features:

• Low platelet count
• Low white blood cell count
• Various types of anemia
• Wilson’s disease
• Hemochromatosis

Wilson’s disease is also known as copper storage disease. Hemochromatosis is an iron storage disease. Delayed blood clotting can also have physical causes that need to be investigated.

In hematology, malignant blood disorders include, for example:

• Acute and chronic leukemias: blood cancer originating in bone marrow cells
• Myelodysplastic syndromes: a stem cell disorder of the hematopoietic system (bone marrow disorder)
• Malignant lymphomas: cancers of the lymphatic system (lymph node cancer)
• Multiple myeloma: malignant proliferation of antibody-producing blood cells
• Myeloproliferative disorders: also a stem cell disorder of the hematopoietic system (bone marrow disorder)

Leukemia (also known as blood cancer) refers to a group of cancers of the hematopoietic system @ pikovit /AdobeStock

As with any medical examination, the doctor begins by asking about the patient’s medical history, medications, and current symptoms (medical history).

During the physical examination, the doctor looks for:

• Abnormalities, such as changes in the color of the skin and mucous membranes
• Swollen lymph nodes in the neck, armpits, and groin

The doctor assesses enlarged lymph nodes based on their texture, tenderness, and mobility.

If there are signs of a blood disorder, the doctor will also palpate other organs, such as the spleen and liver. If necessary, the doctor will examine them more closely using an ultrasound (sonography).

A very important component of hematological diagnostics is a detailed blood count. This allows the doctor to determine the composition of the blood.

The complete blood count includes:

• Composition of blood cells (red blood cells = erythrocytes, white blood cells = leukocytes, blood platelets = thrombocytes)
• The ratio of the cells to one another
• Identification of different types of leukocytes
• Appearance of blood cells
• Measurement of hemoglobin (Hb) and red blood cells, such as the Hb level and the MCV (mean corpuscular volume)

Based on the complete blood count, a hematologist can already identify diseases and assess how far the disease has progressed.

A blood count shows the composition of the blood; there are two types: the complete blood count (CBC) and the differential blood count @ Prathankarnpap /AdobeStock

During a bone marrow examination, doctors extract bone marrow from the patient (bone marrow aspiration). They then stain the sample and examine it under a microscope (cytomorphology). This sometimes allows for more precise conclusions regarding blood formation and any potential blood disorders.

During a bone marrow aspiration, doctors remove a tissue sample from the bone marrow @ FrogMugiArt /AdobeStock

In addition, there are other specialized tests that help establish a correct diagnosis, such as:

• Flow cytometry (more precise characterization of cells)
• Cytogenetics (examination of chromosomal abnormalities)
• Molecular genetics (genetic testing)
• Histopathology (examination of tissue samples)

In some cases, the hematologist may also need to remove a lymph node. This in-depth examination can either confirm or rule out the suspicion of lymph node cancer.

If there is a suspicion that blood cancer cells have spread to other organs, further tests are required.

These may include imaging tests such as:

• X-ray, CT, MRI, ultrasound
• ECG (electrocardiography) or
• lumbar puncture (examination of cerebrospinal fluid)

Blood disorders vary widely, and so do the treatment approaches.

In the case of malignant blood disorders, it is important for the hematologist to choose a treatment plan tailored to the individual patient.

Chemotherapy is one of the classic forms of treatment for cancer, but it can be associated with significant side effects.

If necessary, a stem cell transplant may be required, which is also performed by a hematologist.

If a malignant blood disorder is incurable, the focus shifts to so-called palliative or supportive care approaches. These are intended to alleviate symptoms and prevent complications.

A stem cell transplant allows new blood stem cells to grow, the immune system to regenerate, and a new hematopoietic system to develop @ mp_images

For benign blood disorders (anemia), a blood transfusion using donor blood is often sufficient. However, drug therapies can also be part of the treatment strategy.

Hematologists are often board-certified specialists in internal medicine, hematology, and oncology (hematologists and oncologists). Specialization training can begin after completing medical school.

Specialty training lasts six years: three years in internal medicine and three years in hematology and oncology. During this time, the physician must perform a specified number of diagnostic procedures and treatments.

As a result, the hematology specialist gains in-depth knowledge in all areas of the diagnosis and treatment of hematological diseases.