Hematology
What is hematology?
Hematology is the study of diseases relating to blood. These diseases include problems relating to blood counts (either being too low or too high), abnormal iron levels, problems relating to the coagulation system (either inadequate blood clotting or excessive blood clotting), and a rare condition known as porphyria.
A hematologist is a physician who has trained in internal medicine and has further advanced training in hematology. Seeing a hematologist does not necessarily mean that you have cancer, although hematologists are also trained in the diagnosis and management of cancers of the blood system.
What are some of the reasons you might be referred to a hematologist?
Abnormal blood counts
There are three basic types of blood cells: red blood cells, white blood cells, and platelets. For each type of cell, there are diseases associated with having too little or too many of these cell types, see the table below.
| Disease | Cell Type | Count |
| Anemia | Red Blood Cell | Low |
| Polycythemia | Red Blood Cell | High |
| Leukopenia | White Blood Cell | Low |
| Leukocytosis | White Blood Cell | High |
| Thrombocytopenia | Platelet |
Low |
| Thrombocytosis | Platelet | High |
Each of these abnormalities may be caused by a variety of conditions, and your hematologist must consider many factors. Examples include medications, hormonal conditions, certain organ diseases, bleeding, infections, recent surgery, or an acute illness. Sometimes the abnormal blood counts may be the result of a disease of the bone marrow itself and a bone marrow examination may be necessary if this is the case.
Abnormal iron levels
Iron deficiency is a common condition and it is usually not difficult to identify the cause. Sometimes, however, the usual signs of iron deficiency may not be apparent, or sometimes the deficiency does not respond readily to iron supplements. There are diseases that interfere with your body’s ability to absorb or its ability to utilize the iron in your system.
Iron can also be present in excess, and diseases in this category, such as hemochromatosis, require timely diagnosis and treatment.
Coagulation disorders
The coagulation system helps to stop bleeding after an injury. If there is a deficiency in the ability to form clot this could result in easy bleeding and bruising. This may be relatively minor, and may result in delaying a(your)* planned surgery or dental work. However, coagulation disorders may complicate a pregnancy, and in some situations may be life-threatening. Furthermore, some of the disorders in this category are hereditary and making a diagnosis may be important for your relatives.
Sometimes the coagulation system works too well, causing blood clots to develop spontaneously. These conditions may also be hereditary, but may also be related to other medical conditions as well. Identifying your blood clotting abnormally will help to determine the appropriate anticoagulation therapy.
Malignancies of blood
As with other cells in the body, blood cells can become cancerous. When they do so, these malignant cells go wherever blood circulates. Therefore the approach to blood malignancies is very different from that of other kinds of cancers; typical treatments use chemotherapy rather than radiation or surgery. And since blood is manufactured in the bone marrow, an examination of the bone marrow is often a part of an initial evaluation. Diseases in this category include leukemia, myeloma, and lymphoma. Please see our section on cancer for these diagnoses.
Porphyria
Hemoglobin is the protein in red blood cells that transports oxygen molecules to your vital organs. Within the hemoglobin molecule lies a smaller molecule called heme that holds the oxygen molecule. The heme molecule is synthesized in a complex assembly-line system. When someone is born with a genetic defect in this assembly line, a malfunction occurs. The incompletely-assembled heme precursor molecules build up and accumulate within the tissues of the body, such the skin, liver or nerves. The toxic by-products can cause a variety of symptoms that can often be difficult to diagnose. Porphyria can be hereditary and may also afflict other family members.
There are many conditions for which you may be referred to see a hematologist. The physicians and nurse practitioners at Pacific Oncology are happy to provide resources to help you understand your condition and its treatment.
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