A hematologist is a medical specialist focused on conditions affecting the blood, bone marrow, and lymphatic system. This article outlines the conditions they treat and situations that might lead to a consultation.
Understanding the Role of a Hematologist
A hematologist is a physician with advanced training in diagnosing, treating, and preventing diseases related to blood, bone marrow, and the lymphatic system. This medical specialty, known as hematology, addresses both non-cancerous (benign) and cancerous (malignant) blood disorders.
Hematologists may work in various settings, including hospitals, clinics, and blood banks. Some are also trained in oncology, specializing in blood cancers, and are referred to as hematologist-oncologists. However, a referral does not automatically mean a cancer diagnosis, as they treat a wide array of conditions.
Conditions Treated by a Hematologist
Hematologists manage a diverse range of conditions impacting the blood and its components.
Anemias are common conditions characterized by insufficient healthy red blood cells or low hemoglobin levels, reducing oxygen transport. Types include iron-deficiency, vitamin B12 deficiency, and inherited forms like sickle cell anemia and thalassemia. Aplastic anemia, where bone marrow stops producing enough red blood cells, is also treated.
Bleeding disorders involve problems with the blood’s ability to clot effectively. Examples include hemophilia, a rare inherited disorder lacking specific clotting factors, and von Willebrand disease, the most common inherited bleeding disorder affecting a protein necessary for clotting. Platelet disorders, involving too few or abnormal platelets, can also lead to excessive bleeding.
Clotting disorders, or thrombotic disorders, occur when blood clots form excessively or inappropriately within blood vessels. These include deep vein thrombosis (DVT), clots in deep veins, and pulmonary embolism (PE), where a clot travels to the lungs. Hematologists also manage thrombophilia, an increased tendency to form blood clots, which can be inherited.
Blood cancers affect blood cells, bone marrow, and the lymphatic system. Hematologists diagnose and treat types including leukemia, which originates in blood-forming cells, and lymphoma, affecting the lymphatic system. Multiple myeloma, a cancer of plasma cells in the bone marrow, and myelodysplastic syndromes, where bone marrow produces abnormal blood cells, are also within their expertise.
Bone marrow disorders involve conditions where the bone marrow, responsible for producing blood cells, does not function correctly. These can lead to issues with red, white, or platelet cell production. Hematologists address these underlying problems.
When a Referral to a Hematologist May Be Needed
A primary care physician may recommend seeing a hematologist based on specific symptoms or abnormal laboratory findings. Persistent symptoms that do not resolve with general treatment often warrant specialized evaluation. These can include unexplained fatigue or weakness, which might indicate anemia. Easy bruising or prolonged bleeding from minor cuts, frequent nosebleeds, or heavy menstrual bleeding can suggest a bleeding or platelet disorder. Other concerning symptoms include swollen lymph nodes that persist without an obvious infection, recurrent infections, unexplained fevers, night sweats, or unexplained weight loss.
Unexplained blood clots, such as deep vein thrombosis (DVT) or pulmonary embolism (PE), also necessitate a hematology referral. Abnormal results from routine blood tests, particularly a complete blood count (CBC), are a common reason for referral. Consistently high or low levels of red, white, or platelet cells can signal a blood disorder. If anemia’s cause is unclear after initial workup, or if multiple blood cell lines are abnormal, a hematologist’s expertise is sought. A family history of certain blood disorders, such as sickle cell anemia or hemophilia, can also prompt a referral.
What to Expect During a Hematology Consultation
During a hematology consultation, the specialist will conduct a thorough assessment to understand the patient’s medical history and current symptoms. This includes a detailed discussion of past illnesses, medications, and any family history of blood disorders. A physical examination will also be performed.
Based on this initial assessment, the hematologist will typically order various diagnostic tests to pinpoint the specific condition. Common tests include a complete blood count (CBC), which measures different blood cell types. Blood smears allow for microscopic examination of blood cells, while coagulation studies assess how well blood clots. Iron studies and vitamin B12/folate levels are often checked to investigate anemias. More specialized tests, such as hemoglobin electrophoresis for inherited anemias or genetic tests, may be used. If a bone marrow issue is suspected, a bone marrow biopsy and aspiration might be performed. This procedure involves collecting a small sample of bone marrow for analysis to identify abnormalities in blood cell production. After reviewing all test results, the hematologist will establish a diagnosis and discuss a tailored treatment plan.