Hematology

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Evidence Based Medicine
Cochrane Collaboration on Hematology Bandolier on Hematology TRIP on Hematology
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Ongoing Trials on Hematology at Clinical Trials.gov Trial results on Hematology Clinical Trials on Hematology at Google
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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 B₁₂ 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)

External links

• American Society of Hematology
• BloodLine
• Major milestones in history of hematology (PDF)
• Multilingual index
• Extensive Hematology Slide Collection

Additional Resources

• Hematologists
• Blood disorders
• Hematology topics

v • d • e Pathology: hematology, myeloid hematologic disease (primarily D50-D77, 280-289)
RBCs/ hemoglobinopathy	+ Polycythemia - Macrocytosis - Anemia Nutritional Iron deficiency anemia (Plummer-Vinson syndrome), Megaloblastic anemia (Pernicious anemia) Hemolytic Hereditary enzyme: G6PD Deficiency - Pyruvate kinase deficiency - Triosephosphate isomerase deficiency hemoglobin: Thalassemia - Sickle-cell disease/trait membrane: Hereditary spherocytosis - Hereditary elliptocytosis - Hereditary stomatocytosis Acquired Autoimmune (Warm, Cold), HUS, MAHA, PNH, PCH, Myelophthisic Aplastic Acquired PRCA, Diamond-Blackfan anemia, Fanconi anemia, Sideroblastic anemia Blood tests Normocytic - Microcytic - Macrocytic - Normochromic - Hypochromic Other Methemoglobinemia
Coagulation/platelets/ coagulopathy/ bleeding diathesis	+ Hypercoagulability primary: Antithrombin III deficiency - Protein C deficiency/Activated protein C resistance/Protein S deficiency/Factor V Leiden - Hyperprothrombinemia acquired: DIC (Congenital afibrinogenemia, Purpura fulminans) - autoimmune (Antiphospholipid) Other Essential thrombocytosis - clotting factor: Hemophilia (A/VIII, B/IX, C/XI) • Von Willebrand disease • Hypoprothrombinemia/II - XIII platelet function: Bernard-Soulier syndrome - Glanzmann's thrombasthenia - Gray platelet syndrome - May Hegglin anomaly - Pelger-Huet anomaly Purpura: Henoch-Schönlein, ITP (Evans syndrome), TTP Thrombocytopenia (Heparin-induced thrombocytopenia)
Monocytes/ macrophages	+ Histiocytosis WHO-I (Langerhans cell histiocytosis) WHO-II/non-Langerhans-cell (Juvenile xanthogranuloma, Hemophagocytic lymphohistiocytosis) WHO-III/malignant (Acute monocytic leukemia, Malignant histiocytosis, Erdheim-Chester disease) Other Chronic granulomatous disease -cytosis: Monocytosis - -penia: Monocytopenia
Granulocytes	+ -cytosis: granulocytosis (Neutrophilia, Eosinophilia, Basophilia) - -penia: Granulocytopenia/agranulocytosis (Neutropenia/Kostmann syndrome, Eosinopenia, Basopenia)
See also hematological malignancy and immune disorders

v • d • e Transfusion medicine
General concepts	Apheresis  (Plasmapheresis, Plateletpheresis, Leukapheresis) - Blood transfusion - Coombs test - Cross-matching - Exchange transfusion - International Society of Blood Transfusion - Intraoperative blood salvage - ISBT 128 - Transfusion reactions
Human blood group systems  - Blood type	ABO - Chido-Rodgers - Colton - Cromer - Diego - Dombrock - Duffy - Gerbich - GIL - Hh - Ii - Indian - JMH - Kell (Xk) - Kidd - Knops - LW - Lewis - Lutheran - MNS - OK - P - Raph - Rh - Scianna - T-Tn - Xg - Yt - Other
Blood products	Blood donation - Blood substitutes - Cryoprecipitate - Platelets - Plasma - Red blood cells - Whole blood

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v • d • e WikiDoc Research Resources for Hematology
Articles on Hematology	Most recent articles on Hematology • Most cited articles on Hematology • Review articles on Hematology • Articles on Hematology in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Hematology	Powerpoint slides on Hematology • Images of Hematology • Photos of Hematology • Podcasts & MP3s on Hematology • Videos on Hematology
Evidence Based Medicine Regarding Hematology	Cochrane Collaboration on Hematology • Bandolier on Hematology • TRIP on Hematology
Cost Effectiveness of Hematology	Cost Effectiveness of Hematology
Clinical Trials Involving Hematology	Ongoing Trials on Hematology at Clinical Trials.gov • Trial results on Hematology • Clinical Trials on Hematology at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Hematology	US National Guidelines Clearinghouse on Hematology • NICE Guidance on Hematology • NHS PRODIGY Guidance • FDA on Hematology • CDC on Hematology
Textbook Information on Hematology	Books and Textbook Information on Hematology
Pharmacology Resources on Hematology	Dosing of Hematology • Drug interactions with Hematology • Side effects of Hematology • Allergic reactions to Hematology • Overdose information on Hematology • Carcinogenicity information on Hematology • Hematology in pregnancy • Pharmacokinetics of Hematology •
Genetics, Pharmacogenomics, and Proteinomics of Hematology	Genetics of Hematology • Pharmacogenomics of Hematology • Proteomics of Hematology
Newstories on Hematology	Hematology in the news • Be alerted to news on Hematology • News trends on Hematology
Commentary on Hematology	Blogs on Hematology
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