Hematology is the study of blood, blood forming organs and blood diseases. It involves the study of the diagnosis, treatment, outcome and prevention of blood diseases. Hematology includes investigation of red blood cells, white blood cells, platelets, blood vessels, bone marrow, lymph nodes, and organs such as the spleen. Hematologists also study the fluid portion of blood (plasma) which has important proteins such as those involved in bleeding and clotting. Blood diseases can affect both the production and destruction of red blood cells, white blood cells, platelets or plasma-clotting proteins.
Blood is key to help you function normally. Red blood cells carry oxygen to cells throughout your body, white blood cells help you fight infections and help with your immunity, while platelets assist in stopping bleeding as do plasma-clotting proteins. Having a healthy supply of blood is important for your overall health.
A hematologist is a medical doctor who applies this specialized knowledge to treat patients with blood conditions.
Hematologic medical conditions which deserve focused attention include: anemia, including iron deficiency anemia, platelet and white blood cell disorders sickle cell disease and bleeding and clotting disorders
Anemia refers to a low level of red blood cells (RBC). People with anemia don’t have enough RBCs or hemoglobin. RBCs carry oxygen to organs and tissues and remove carbon dioxide. Red blood cells have three components: membrane, hemoglobin and enzymes (to help give the cell the energy it needs). Inherited or acquired conditions may occur with all three components. Hemoglobin is the protein/pigment in RBCs that carries oxygen to the cells. Red blood cells are disc-shaped and look like doughnuts without holes in the center. Red blood cells are made in bone marrow — a sponge-like tissue inside the bones. They live for about 120 days in the bloodstream, then are removed from circulation with their important components (iron, proteins) reused.
Anemia has three main causes: blood loss, lack of red blood cell production, or high rates of red blood cell destruction. Lack of iron, folate or vitamin B12 in the diet may contribute to lack of red blood cell production. To help determine the most likely cause of anemia, most hematologists use the automated complete blood count (CBC) and the measurements it provides, along with an assessment of the number of young red blood cells (reticulocyte count) and review of a blood smear.
When you have anemia, your body lacks oxygen, so you may experience one or more of these symptoms:
- Shortness of breath
- Fast or irregular heartbeat
- Pounding in your ears
- Cold hands or feet
- Pale or yellow skin
- Yellow or jaundiced eyes
- Abdominal pain
- Chest pain
Common types of anemia based on the size of the red cell and the number of young RBC:
1) Small RBC size (microcytic anemia)
- Iron deficiency
- Thalassemia trait or disease
- Lead poisoning
2) Large RBC size (macrocytic anemia)
- Folate or Vitamin B12 deficiency
- Liver disease
- Failure of the bone marrow to produce RBC, either from an inherited or acquired condition such as leukemia or damage to the bone marrow from drugs or infection (aplastic anemia)
3) Normal RBC size –
With no young RBC (reticulocytes)
With normal number of reticulocytes
- Aplastic anemia
- Leukemia or other cancer
With increased number of reticulocytes (hemolytic anemia)
- Chronic infections or inflammation
- Kidney disease
- Defects to the RBC membrane, such as hereditary spherocytosis
- Absence of important RBC enzymes such as G6PD deficiency
- Abnormalities to hemoglobin such as sickle cell disease
- External defects to the RBC which cause them to be destroyed more quickly, such as antibodies, abnormal heart valves or infections (DIC)
Iron-deficiency anemia is a common, easily treated condition that occurs if you don't have enough iron in your body. Low iron levels usually are due to blood loss (from excessive menstrual bleeding or loss of blood from the intestinal tract), poor diet, or an inability to absorb enough iron from your intestinal tract.
Iron-deficiency anemia usually develops over time if your body doesn't have enough iron to build healthy red blood cells. Without enough iron, your body starts using the iron it has stored. Soon, the stored iron gets used up.
After the stored iron is gone, your body makes fewer red blood cells. The red blood cells it does make have less hemoglobin than normal.
Iron-deficiency anemia can cause fatigue (tiredness), shortness of breath, chest pain, and other symptoms. Severe iron-deficiency anemia can lead to heart problems, infections, problems with growth and development in children, and other complications.
Infants and young children and women are at the highest risk for iron-deficiency anemia. It can be easily screened and treated.
BloodCenter’s adult hematology program, which resides within Froedtert Clinical Cancer Center, is part of its Division of Hematology/Oncology. Our pediatric hematology program resides within Children’s Hospital of Wisconsin clinics. The comprehensive bleeding and clotting program resides within the BCW but patients are seen in Children’s Hospital and in Froedtert Hospital. Our physicians bring expert care to patients with anemia, platelet and white cell disorders, bleeding and clotting disorders.
The Adult Benign Hematology Service is a partnership of BloodCenter of Wisconsin, Froedtert Hospital, and the Medical College of Wisconsin. This partnership has created the infrastructure for a clinical home in which to carry out coordinated short-term and long-term care for patients with benign hematologic disorders.
The goals of the program are:
- Create a premier adult Benign Hematology Service, including sickle cell disease, for clinical care, translational research, and education
- Provide clinical care and a consultative service to the adult academic medical center
- Improve adult practice hematology training for hematology/oncology fellows
- Enhance collaboration among BloodCenter of Wisconsin, Froedtert Hospital, and the Medical College of Wisconsin clinical and research programs
- Build community infrastructure to support clinical services, research and outreach