Why Have I Been Referred To Haematology
Haematology is the branch of medicine concerned with diseases and disorders affecting the blood. The word haematology comes from Greek roots meaning “blood” and “-logia”. This specialty covers all aspects of the physiology, pathology, diagnosis, treatment and prevention of diseases of the blood and its components – red cells (haemorrhage), white cells (leukaemia) and platelets (thrombosis). In most countries the term haematologist is used to denote doctors who have specialised training in this field.
Most patients referred to a medical practitioner will not require a full workup as their problem can usually be diagnosed at first instance without any further investigation. However some problems do need urgent attention because they pose serious threats to life such as severe anaemia requiring immediate treatment with iron, low oxygen levels causing shortness of breath (hypoxaemia) which needs prompt management with high-flow oxygen therapy or bleeding into an area where it cannot be effectively managed, such as into a pulmonary artery causing stroke or into the brain causing intracranial bleed. Other conditions such as sickle cell anaemia, myeloproliferative syndrome or leukaemia need urgent investigations to determine whether they are responding well to treatments and if there is a need to change them.
In addition to these emergency situations, many other referrals come from primary care physicians when they suspect something is wrong with the blood but want confirmation before making a final decision about what action to take. Some examples include:
Testicular tumours involving male children
A family history of thalassaemia
Suspected immune deficiency
Bone pain caused by metastatic cancer
Anaemia due to chronic kidney disease
Low back pain possibly due to spinal stenosis
Headache possibly due to sinusitis
Fever possibly due to infection
Swelling of hands or feet possibly due to rheumatoid arthritis
Tender enlarged liver
Skin lesions on arms or legs
Chest pain due to lung carcinoma
Bloody stools due to rectal carcinoma
Hoarseness due to throat cancer
Weight loss due to small bowel carcinoma
Bloating or indigestion due to stomach ulcer
Sore mouth due to oral cancer
All referrals should be made thoughtfully after careful consideration of your personal circumstances and preferences. It is important for you to talk things over with your GP so he/she knows why you want a second opinion. If you think your condition is more serious than it really is, then consider talking to a specialist instead of just going along with what your GP says. Sometimes GPs don’t know enough about certain conditions to make a proper assessment, especially if you live outside Australia or New Zealand.
If you decide you want to see a specialist, then the next step is to find out how easy or difficult it would be to get to his place of practice. You may also wish to ask him how his fees compare with those charged by other specialists in the same field. Remember, however, that there are no hard and fast rules regarding cost. For example, one haematologist charges far less than another simply because he has fewer patients under his care.
It’s often best to consult several different specialists until you’ve found someone whose opinions match yours exactly. While it might seem like a waste of time to visit multiple clinics, remember that each expert is likely to bring a unique perspective to bear on your situation.
So now you know what haematologists do and why they’re needed, let’s look at some of the tests they carry out.
Blood Count Tests
A blood count test measures various parameters of your blood including red cells, white cells and platelets. These tests detect changes in the numbers of cells within your bloodstream that indicate disease processes. Your blood counts will show how healthy your body is compared with people of similar age and sex. Normal values vary according to your gender and ethnic group.
Your blood contains four types of blood cells called erythrocytes or red cells. Red cells help transport oxygen throughout your body.
An abnormally shaped red cell indicates anaemia and could be a sign of a variety of diseases. Causes range from nutritional deficiencies to infections, autoimmune reactions and genetic defects.
There are three main types of white cells in your blood: neutrophils, eosinophils and basophils. They play key roles in the immune system. Neutrophils fight against bacteria and viruses; eosinophils release chemicals that cause inflammation and swelling; and basophils produce histamine and slow down clotting. An increase in number of any type of white cell suggests inflammation or infection.
Thrombocytes or platelets form plugs in blood vessels to prevent excessive bleeding. When stuck together, platelets aggregate to form a plug that prevents the flow of blood through narrow tubes (such as those inside the heart, lungs and kidneys). Platelets also help control bleeding by forming aggregates around damaged tissue and stopping blood flow to the injured area. Abnormalities in platelet function suggest a wide range of underlying causes, including trauma, injury, infection, exposure to toxins, hereditary disorders and malignancy.
Bone marrow is a soft tissue located beneath our skin and lining our bones. Its chief function is to manufacture blood cells, particularly red cells. Diseases of the bone marrow affect every organ in the body, including the nervous system, muscles, joints, teeth, gums, skin, eyes, ears and nose. Many cancers, such as acute myelogenous leukemia (AML) and lymphomas, develop by destroying bone marrow. Conditions such as thalassemia, sickle cell disease and Gaucher’s disease arise because genes fail to express adequately.
Blood Biochemical Analysis
Blood biochemical analysis includes measuring substances produced by your cells that serve specific functions. These measurements provide clues to the functioning of your organs. Examples include thyroid hormone testing, ammonia testing for hepatic encephalopathy, lactate dehydrogenase testing for muscle damage and creatine kinase MB testing for cardiac damage.
Blood Gas Analysis
This test checks the level of oxygen and carbon dioxide in the blood and helps diagnose respiratory distress. It’s done using blood samples taken from either a vein in your hand or arm or from a peripheral site, such as the earlobe.
Blood Electron Microscopy
This procedure uses a microscope to examine blood smears stained with stains that react to particles present. Examination of blood cells under a microscope provides information about the shape, size and distribution of blood cells.
This test checks for bacteria growing in the blood culture bottle. Bacteria are detected after incubation (a process that allows microorganisms to multiply); normally, bacteria only grow in the laboratory setting.
Blood Immunofluorescence Testing
This test identifies antibodies bound to antigens in your blood. Antibodies are proteins manufactured by your immune system that protect you from infectious organisms. When an antibody attaches itself to an antigen, it marks the target organism for destruction by other white blood cells. Each antibody reacts specifically to a particular antigen.
Blood Molecular Diagnostic Testing
Molecular diagnostic testing involves extracting DNA from blood and testing it for mutations associated with inherited disorders such as cystic fibrosis, fragile X syndrome and Tay-Sachs. Genetic screening tests identify carriers of genetic disorders (carrier status) while prenatal testing detects fetal chromosomal abnormalities.
Blood Flow Studies
Blood flow studies measure the speed and volume of blood flowing through arteries and veins. They may involve ultrasound scanning, Doppler techniques, nuclear magnetic resonance imaging (MRI) or computed tomography (CT scan). Blood flow studies can detect blockages, such as arteriovenous fistulas, and assess the effectiveness of therapies, such as bypass grafting surgery.
Blood smears are microscopic preparations of blood cells obtained by drawing blood into a capillary tube and spreading the contents across a slide. Blood smear preparations allow a trained technician to study blood cells under a light microscope.
Blood typing refers to the identification of antigens present on the surface of red blood cells. Antigens differ between individuals and can be grouped into broad categories based upon the presence of antigens known as human serological systems. Blood grouping determines compatibility between donors and recipients of transfusions.
Screening for hepatitis is done with a rapid enzyme immunoassay test to check for antibodies against Hepatitis C virus (HCV) or Hepatitis B virus (HBV). People infected with HCV or HBV are contagious during the early stages of illness, and therefore must receive antiviral medications promptly.
Human Leukocyte Antigen (HLA) Matching
HLA matching is performed for solid organ transplants or stem cell transplantation. HLA matches are crucial for successful organ transplants. HLA molecules are responsible for binding and presenting antigens (specific foreign proteins) to the immune system. Certain combinations of HLA molecules are considered compatible with other donor tissues or organs.
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