Hematology

Editor-In-Chief: Robert Killeen, MD

Associate Editor-In-Chief:

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)

Hematology as basic medical science

 * Blood
 * Venous blood
 * Venipuncture
 * Hemopoiesis
 * Blood tests
 * Cord blood
 * Red blood cells
 * Erythropoiesis
 * Erythropoietin
 * Iron metabolism
 * Hemoglobin
 * Glycolysis
 * Pentose phosphate pathway
 * Reticuloendothelial system
 * Bone marrow
 * Spleen
 * Liver
 * Lymphatic system
 * Blood transfusion
 * Blood plasma
 * Blood bank
 * Blood donors
 * Blood groups
 * Haemostasis
 * Coagulation
 * Vitamin K
 * Complement system
 * Immunoglobulins

Classification of hematologic diseases

 * Hemoglobinopathies (congenital abnormality of the hemoglobin molecule or of the rate of hemoglobin synthesis)
 * Sickle-cell disease
 * Thalassemia
 * Methemoglobinemia
 * Anemias (lack of red blood cells or hemoglobin)
 * Iron deficiency anemia
 * Megaloblastic anemia
 * Vitamin B 12 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
 * Fanconi anemia
 * Diamond-Blackfan anemia
 * Acquired pure red cell aplasia
 * 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
 * Thrombocytopenia
 * Glanzmann's thrombasthenia
 * Wiskott-Aldrich syndrome
 * Miscellaneous
 * Haemochromatosis
 * Asplenia
 * Hypersplenism
 * Gauchers disease
 * Monoclonal gammopathy of undetermined significance
 * Hematological changes secondary to non-hematological disorders
 * Anemia of chronic disease
 * Infectious mononucleosis
 * AIDS
 * Malaria
 * Leishmaniasis

Tests
Tests used in the investigation of hematological problems include:
 * Full blood count
 * Erythrocyte sedimentation rate (ESR)
 * Blood film
 * Bone marrow examination
 * Coombs test
 * Diascopy
 * serum Ferritin level
 * Vitamin B12 and Folate levels
 * Prothrombin time
 * Partial thromboplastin time
 * Protein electrophoresis
 * Hemoglobin electrophoresis
 * D-dimer

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)

Additional Resources

 * Hematologists
 * Blood disorders
 * Hematology topics

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