Definition and Overview
A hematologist is a medical specialist that deals with the study, diagnosis and treatment of blood disorders. A patient may be referred by a general physician or family doctor to a hematologist if he is anemic, is suspected of having a blood-related condition, or his primary care provider detects some abnormalities in blood test results.
Who Should Undergo and Expected Results
A general physician may recommend a hematology consultation if the patient is showing symptoms of a blood disorder, which include:
- Heavy menstruation
- Delayed blood clotting after wound, injury, or surgery
- Easy bruising
- Frequent nosebleeds
- Excessive bleeding from small wounds
- Bleeding into joints
- Shortness of breath
- Bloody urine
- Swollen lymph nodes
Petechia, or pinpoint skin rashes due to low platelet counts
A physician may also make the referral if the patient’s blood test result shows:
Abnormally low red blood cell count
- Abnormally low white blood cell count
- Persistently high white blood cell count
- Decreased platelets
- Decreased blood clotting factors
These abnormalities can be caused by several factors and are not always due to a serious disease. Some of them may be caused by minor infections or even as a side effect of some medications. However, they may also indicate serious blood disorders, so it is best to have them checked by a specialist.
The following are the different types of blood disorders that a hematologist can diagnose and treat:
- Anemia – This is a serious condition caused by an abnormally low number of red blood cells, unusual heavy menstrual bleeding in women, the lack of iron in the body (leading to iron-deficiency anemia) or lack of vitamin B12 (leading to pernicious anemia). More severe forms of anemia include aplastic anemia, or when the bone marrow is unable to produce a sufficient amount of red blood cells, and autoimmune hemolytic anemia, or when the body’s immune system destroys its own red blood cells.
- Sickle cell anemia – This is a hereditary form of anemia wherein a person is born with unusually sticky red blood cells that obstruct blood flow resulting in severe pain or even organ damage.
- Platelet disorders, such as von Willebrand disease – This is an inherited blood disorder caused by the lack of the von Willebrand factor, which help blood to clot.
- Polycythemia vera – This is a condition wherein the body produces an abnormally high level of blood cells.
- White blood cell disorders – This is when there is too much or too little white blood cells in the body. Some examples include lymphoma, multiple myeloma and leukemia.
- Leukemia – This is a form of cancer of the blood wherein a white blood cell becomes malignant and begins to multiply within the bone marrow, from which the malignant cells can spread all over the body.
- Hemophilia A and B – These are conditions caused by low levels of clotting factors in the blood, leading to unusual or heavy bleeding into joints and the inability of the blood to clot properly.
- Blood clots – Blood clots may cause serious health risks when they form inside the body. Depending on their location, they can lead to different conditions such as pulmonary embolism (when the clot forms in one of the pulmonary arteries) and deep vein thrombosis (when the clot forms in one of the body’s deep veins).
At the end of a consultation, the hematologist may be able to provide the patient with a diagnosis and a recommended treatment plan, or if the tests performed by the general physician do not provide sufficient information, he may order more specialized tests to help detect a blood disorder.
How the Procedure Works
During the consultation, the hematologist will first look at the patient’s existing records, such as:
- Medical history
- Recent laboratory tests
- Blood test results
He will also ask the patient about his symptoms and any unusual blood-related problems, such as prolonged or excessive bleeding. It is important to give the hematologist as much information as possible to help him arrive at a conclusive diagnosis.
If the results of the initial tests are inconclusive, he will request for:
- Complete blood count
- Platelet aggregation tests
- Bleeding time measurement
Some of these tests may be done during the same visit while some may be scheduled at a later time. If there are no tests done, the initial consultation takes just about 20 minutes. If the patient consents to have the tests done, the time may extend up to one hour.
Possible Risks and Complications
A hematology consultation is a safe routine visit to a hematologist, and poses no risks to the patient, unless some tests are done during the same appointment. Although most laboratory blood tests are safe and cause minimal discomfort when the blood samples are being taken, some tests, such as a bone marrow biopsy, may be more painful. This test is also linked to some risks, such as:
- Allergic reaction to anaesthetics used
- Excessive bleeding
- Prolonged pain or discomfort at the site where the biopsy is performed
To help prevent these complications, the hematologist will give the patient some instructions prior to the procedure.
Going to a hematology consultation will also help the patient get the necessary treatment for his blood-related disorder. Hematologists typically recommend any of the following treatment options:
- Iron supplements
- Blood transfusion
- Factor replacement therapy, or injecting clotting factor concentrates to prevent and control bleeding
Frozen plasma transfusions
If left untreated, blood-related disorders can cause serious complications such as:
- Bleeding into joints
- Bleeding into the brain
Bleeding inside the intestines
American Society of Hematology