Benign hematology

What is Benign Hematology?

AVAM Cancer & Blood Specialists are experts in hematology, which is a branch of medicine that involves studying the blood, blood-forming organs (such as the bone marrow), and blood diseases. Abnormalities in peripheral blood counts can either reflect primary hematologic disease or secondary response to systemic disease, hematologists deal with a broad array of diseases.

These range from hematologic disorders, sickle cell disease and hemophilia, to premalignant disorders, myelodysplasia or myeloproliferative neoplasms, to cytopenias that reflect a complex response to renal disease, liver disease, systemic inflammatory disease, autoimmune disease, or systemic infections.

Benign hematology is a subset of hematology that focuses on non-cancerous blood disorders such as anemia, elevated and decreased blood cells, blood clotting disorders, bleeding disorders, iron overload or deficiency syndromes and several rare diseases.

Common Symptoms of Benign Hematology Disorders

Symptoms of hematologic disease depend on many factors. Depend on which cell type is affected and how low or high the count. This is determined through a complete blood count. In anemia, there is a low number of hemoglobin.

Symptoms include:

Fatigue, dizziness, loss of concentration, noise in the ear, shortness of breath, and fast heartbeat.

A low platelet count or thrombocytopenia can symptoms include in excessive bruising, red spots on the lower extremities, nose bleeds, bleeding from the mouth and gums, and blood in the urine or stools. Low numbers of white cell count for (leukopenia or neutropenia) can cause repeated bacterial infections.

Other symptoms have effects on iron metabolism causing chronic anemias (known as the anemia of chronic disease). They can also suppress bone marrow, as in systemic lupus erythematosus and other chronic inflammatory conditions.

How are Benign Hematology Disorders Diagnosed?

A hematologist can select from a vast array of laboratory tests to help diagnose blood disorders, based on a patient’s symptoms and the results of a physical examination. A blood disorder may cause no symptoms, but is discovered when a laboratory test is done for another reason. This test requires blood samples taken in our phlebotomy lab here at AVAM Cancer & Blood Specialists. Some patients may have lab tests performed at a different location, but those results will be shared with our hematologist for further analysis.

Other testing is needed to rule out hemolysis or destruction of red blood cells. Still further testing is required to look for the presence of organ problems (kidney, liver, lung, thyroid), connective tissue disorders (lupus erythematosus, rheumatoid arthritis), and cancer, all of which can have indirect effects on the bone marrow or blood.

Detailed workup in hematology often requires complex, multistep tests. Long-term trends of lab values are very helpful in making some diagnoses.

A bone marrow biopsy is an invasive test and is used to study the appearance of the bone forming cells. This is often used in workup of benign hematology disorders when simple blood tests fail to reveal a cause of the illness.

Increasingly, genetic tests are playing a role in blood disorder diagnoses. DNA extracted from blood cells or freely circulating in blood is analyzed to find characteristic changes that define certain diseases. These tests are highly accurate and very sensitive.

What are the Treatment Options for Benign Hematology Diseases?

Treatments vary depending on the type of disease, its severity and impact on quality of life. It can include simple observation, use of steroids and other immune-modulating therapies, transfusions or coagulation factor support, growth factor supplementation or nutrient repletion.

Anemia

For chronic or acute anemia, the underlying disease (infection, arthritis, heart, lung or kidney disease) is attended to, often improving the anemia. If that’s not possible and the patient’s anemia is causing symptoms, red blood cell transfusions may be necessary. Recombinant erythropoietin can be given, weekly or biweekly, and usually indefinitely.

Thrombocytopenia (low platelet count)

Treatment for low platelets are often directed at the cause. There is a threshold of therapy for this disease since we have a large reserve of platelets and even a relatively low number of platelets may not require treatment because it does not cause life-threatening bleeding. Treatment may include thrombopoietin mimetic to increase platelet production, immune modulation with steroids, platelet transfusion or simply observation.

Because transfused platelets do not last long in the circulation and anti-platelet antibodies can develop upon repeated exposure to transfused or “foreign” cells, platelet transfusion is only used briefly to see the patient through a period of highest risk.

Myeloproliferative diseases-polycythemia vera, essential thrombocythemia, and primary myelofibrosis

This group of diseases is special and overlaps between benign and malignant blood disorders. They may have a long latency period of decades with abnormal lab values before developing a more aggressive phase. They are often characterized by excessive production of blood elements.

In essential thrombocythemia, and in some cases of polycythemia vera, the high platelet count needs to be lowered to heart attack and life-threatening blood clotting. The optimal platelet count in this situation is unknown, largely because the degree of platelet activation, and therefore increased potential for clotting, cannot be routinely measured.

Generally, however, a count of 600,000 (normal: 150,000 to 450,000) is used as a threshold for initiating therapy in myeloproliferative diseases. The patient is experiencing a life-threatening thrombotic event; the platelet count can be brought down very rapidly by mechanical means (plateletpheresis). Otherwise, medications, either hydroxyurea or anagrelide, are used. These drugs suppress the bone marrow cells that make platelets (megakaryocytes) and platelet production, although hydroxyurea has a more global effect on bone marrow function.