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HAEMATOLOGY

Haematology, a pivotal branch of medicine, focuses on the study, diagnosis, treatment, and prevention of blood disorders. This field encompasses an intricate understanding of blood components, including red blood cells, white blood cells, platelets, and plasma, and their vital roles in maintaining homeostasis and overall health.

Anaemia

A condition characterised by a deficiency in red blood cells or haemoglobin, leading to fatigue, pallor, and weakness. Common types include iron deficiency anaemia, pernicious anaemia, and aplastic anaemia. Internists often treat the underlying causes and prescribe iron supplements or vitamin B12 injections as necessary.

1What are the symptoms?
• Feeling cold more often.
• Fatigue
• Feeling weak or tired all the time
• Migraines
• Pain on the tongue’s surface
• Pale complexion
• Dry skin or skin that bruises easily.
• Leg restlessness
• Brittle nails
• Hair loss in some cases
2What does treatment involve?
If you have iron-deficiency anaemia, your doctor will prescribe iron tablets and recommend eating foods containing high amounts of iron and vitamin c.Iron and vitamin c infusions are delivered directly through your blood vessels. Infusions are a much safer option for someone living with chronic kidney disease.

In severe cases, red blood cell transfusions are required when you are hospitalised due to extremely low haemoglobin levels. A red blood transfusion treats anaemia symptoms immediately. This means you will experience immediate relief from anaemic symptoms of tiredness and muscle weakness.
3When should you see your doctor?
Suppose you are experiencing regular episodes of tiredness, dizziness and muscle weakness. In that case, you need to contact your doctor to check your iron levels and determine whether you require long-term treatment through oral iron medication or red blood transfusions. Your doctor will inform you of your condition, whether anaemia or hypoglycaemia and find out what is causing it.

Diagnosis of Leukaemia

This group of cancers affects the blood and bone marrow, leading to the overproduction of abnormal white blood cells. Symptoms may include frequent infections, fatigue, and easy bruising. Internists may collaborate with haematologists and oncologists to manage leukaemia, utilising chemotherapy and targeted therapies as part of the treatment regimen.

1What are the symptoms?
• Lethargy
• Anaemia
• White/pale skin
• Bleeding
• Bruising
• Pain in the bone
• Tender, inflamed gums
• Migraines
• Pain in the chest
2What does treatment involve?
Treatment depends on the stage of leukaemia which is determined by a diagnosis within 24 hours. Diagnostic tests such as a lumbar puncture, CT scan and x-ray of the chest can estimate how far cancer has spread.
With palliative care, most leukaemias are treated with a combination of chemotherapy,radiation therapy in some cases, a stem cell and bone marrow transplant (acute lymphoblastic leukaemia and acute myeloid leukaemia) and surgery to remove your spleen, which is in the case of chronic lymphocytic leukaemia and chronic myeloid leukaemia.
3When should you see your doctor?
You should see your doctor when you experience bleeding for no reason, fever or seizures. You will need to see your doctor immediately when signs of acute leukaemia occur. Leukaemia may also begin to go into remission after treatment, but signs of recurrence may still occur, which is evident when infection and bleeding develops.

Diagnosis of Lymphoma

A malignancy originating in the lymphatic system, lymphoma includes Hodgkin and non-Hodgkin lymphomas. Common symptoms include swollen lymph nodes, fever, and night sweats. Treatment often involves a combination of chemotherapy, radiation, and in some cases, immunotherapy.

1What are the symptoms?
• Swollen lymph nodes in the groin, armpit and neck
• Coughing
• Fever
• Difficulty breathing
• Chills in the night
• Tiredness
• Sudden weight loss
2What does treatment involve?
Treating lymphoma depends on your stage of cancer, including the rate at which it spreads. Your doctor relies on chemotherapy, radiation therapy, immunotherapy as well as a targeted therapy to treat non-Hodgkin’s lymphoma.
Usually, your doctor will use a combination of radiation therapy, chemotherapy and immunotherapy to target and destroy cancer cells in patients with Hodgkin’s lymphoma.
When these treatments are unsuccessful, your doctor will work toward providing you with a stem cell transplant. But before this, you will receive a very high dose of chemotherapy to kill cancer cells and damage stem cells present in the bone marrow. After receiving chemotherapy treatments, you will need new stem cells to replace the old ones.
3When should you see your doctor?
Check-ups are regular, so you need to visit your doctor over the next few months. Afterwards, check-ups should occur after every six months. You can ensure that you do not fall into a relapse whereby cancer returns by attending frequent check-ups. You remain at a high risk of redeveloping lymphoma within the initial two years after getting treated.

Thrombocytopenia

Characterised by a low platelet count, this condition increases the risk of bleeding and bruising. Internists must identify the underlying causes, which may include autoimmune disorders, infections, or medications, and provide appropriate management strategies.

Coagulation Disorders

Conditions such as haemophilia or von Willebrand disease affect the blood's ability to clot properly. Internists play a crucial role in the management of these disorders, often employing clotting factor replacements and lifestyle management strategies to prevent bleeding episodes.

FAQ

1How is leukaemia different from lymphoma?
Both conditions differ according to where the cancer starts, including the cells they attack. For example, leukaemia originates in cells forming blood inside the bone marrow, whereas lymphoma begins in the cells known as lymphocytes that fight infections.
2Why is immunotherapy effective in treating non-Hodgkin’s lymphoma?
Immunotherapy uses your body's cells to destroy cancer cells. Immunotherapy improves your own immune system’s ability to identify and destroy cancer cells. In other words, your cells target and destroy abnormal cells found anywhere in the body.
3Can I take iron tablets if I have kidney disease?
You can purchase iron tablets as over-the-counter medicine, but they are known to cause constipation and may not be absorbed as well for someone living with kidney disease. As a result, if you have kidney disease as well as anaemia, you need to receive intravenous iron regularly.
Haematology

"It all starts by caring enough to engage the patient in the decision-making. Many people argue that 'We don't have time for this in the consultation. I'd rather just tell people what I think is best for them, and then, they can decide whether they want it or not.' Well, that's not very caring. This might be efficient, but it does not reflect the best that we can offer.'"

Dr Victor Montori, on shared decision-making