Clinical Hematology or study of blood disorders is a highly specialised field related to diagnosis , evaluation treatment and treatment of blood disorders. Blood disorders range from simple iron deficiency anemia to highly complex and sometimes difficult to treat leukemia and lymphoma. Blood disorder may present as mild weakness , fatiguability , generalised lymphadenopathy , bleeding or fever.
Whenever a haematological disorder is suspected, It is very important to consult your haematologist and plan treatment.
After a patient presents to us with suspected blood disorder, we immediately start his/ her initial work up , which includes Complete blood counts, Reticulocyte count, peripheral smear etc. Based upon these initial investigations, patients may require further work up , which depends upon the suspected disease. For example, if a patient is suspected to have blood cancer, we plan immediate bone marrow aspiration and biopsy, in addition , some special tests like flow cytometry, cytogenetics / FISH studies are done. If a patient has suspected hemoglobinopathy, or a blood disorder with low Hb from childhood, initial work up includes HPLC and parental studies. We have a complete cancer centre with support from surgical oncology and radiation oncology , so that whenever a patient of say suspected lymphoma comes to us , lymph node biopsy is done on urgent basis and samples sent for histopathology and Immunohistochemistry (IHC) studies.
All these tests are done in house and on priority basis for any patients with suspected blood disorder.
We have a dedicated Hemato oncology unit with state of art 5 bedded BMT facility. Each room has a separate HEPA filter and dedicated staff. We also have a 30 bedded day care centre, where every effort is made to keep our patients as comfortable as possible . Our unit cares for patients with haematological disorders, including benign and malignant diseases like Thalassemia, Anemia, Thrombocytopenia, Aplastic Anemia and Blood cancers like Leukemia , Lymphoma , Multiple Myeloma.
We have in house facility for all high end haematological investigations like Flow cytometry, Cytogenetics, in addition to all routine investigations. Our blood bank offers all support for hematological patients with blood products being available in house 24 x 7. They also perform procedures like apheresis and cryopreservation on routine basis.
Treatment of blood disorders have evolved with time and now our intention in most patients is to achieve complete cure. Whether it is malignancy, thalassemia or any blood disorder, our aim is to make our patient free from his disease, and we try our very best to achieve this Goal. Final modality is decided after complete discussion taking patient and his family into confidence.
We offer following treatment modalities for our patients :
Chemotherapy is the administration of drugs that kill rapidly dividing cells such as leukemia or other cancer cells. Chemotherapy may be taken orally in pill or tablet form, or it may be delivered via a catheter or intravenous line directly into the bloodstream. Combination chemotherapy is usually given, which involves a combination of more than one drug. The drugs are given in cycles with rest periods in between.
Sometimes, chemotherapy drugs for leukemia are delivered directly to the cerebrospinal fluid (known as intrathecal chemotherapy). Intrathecal chemotherapy is given in addition to other types of chemotherapy and can be used to treat leukemia in the brain or spinal cord or, in some cases, to prevent spread of leukemia to the brain and spinal cord.
Side effects of chemotherapy depend on the particular drugs taken and the dosage or regimen. Some side effects from chemotherapy drugs include hair loss nausea, vomiting, mouth sores, loss of appetite, tiredness, easy bruising or bleeding, and an increased chance of infection due to the destruction of white blood cells. There are medications available to help manage the side effects of chemotherapy.
Some adult men and women who receive chemotherapy sustain damage to the ovaries or testes, resulting in infertility. Most children who receive chemotherapy for leukemia will have normal fertility as adults, but depending on the drugs and dosages used, some may have infertility as adults.
Biological therapy is any treatment that uses living organisms, substances that come from living organisms, or synthetic versions of these substances to treat cancer. Biological therapies for various types of cancer can include antibodies, tumor vaccines, or cytokines (substances that are produced within the body to control the immune system).
Monoclonal antibodies are antibodies that react against a specific target that are used in the treatment of many kinds of cancer. Interferons are cell signaling chemicals that have been used in the treatment of leukemia.
Side effects of biological therapies tend to be less severe than those of chemotherapy and can include rash or swelling at the injection site for IV infusions of the therapeutic agents. Other side effects can include headache, muscle aches, fever, or tiredness.
Targeted therapies are drugs that interfere with one specific property or function of a cancer cell, rather than acting to kill all rapidly growing cells indiscriminately. This means there is less damage to normal cells with targeted therapy than with chemotherapy. Targeted therapies may cause the target cell to cease growing rather than to die, and they interfere with specific molecules that promote growth or spread of cancers.
Targeted therapies are given in pill form or by injection.
Side effects can include swelling, bloating, and sudden weight gain. Other side effects can include nausea, vomiting, diarrhea, muscle cramps, or rash.
Radiation therapy uses high energy radiation to target cancer cells. Radiation therapy may be used in the treatment of leukemia that has spread to the brain, or it may be used to target the spleen or other areas where leukemia cells have accumulated.
Radiation therapy also causes side effects, but they are not likely to be permanent. Side effects depend on the location of the body that is irradiated. With any radiation therapy, the skin in the area being treated may become red, dry, and tender. Generalized tiredness is also common while undergoing radiation therapy.
In stem cell transplantation, high doses of chemotherapy and/or radiation are given to destroy leukemia cells along with normal bone marrow. Then, transplant stem cells are delivered by an intravenous infusion. The stem cells travel to the bone marrow and begin producing new blood cells. Stem cells may come from the patient or from a donor. Autologous stem cell transplantation refers to the situation in which the patient's own stem cells are removed and treated to destroy leukemia cells. They are then returned to the body after the bone marrow and leukemia cells have been destroyed.
An allogeneic stem cells transplant refers to stem cells transplanted from a donor. These may be from a relative or an unrelated donor. A syngeneic stem cell transplant uses stem cells taken from a healthy identical twin of the patient.
Stem cells may be removed (harvested) in different ways. Typically, they are taken from the blood. They can also be harvested from the bone marrow or from umbilical cord blood. Stem cell transplantation is done in a hospital, and it is necessary to remain in the hospital for several weeks.
Risks of the procedure include infections and bleeding due to the depletion of normal blood cells. A risk of stem cell transplant with donor cells is known as graft-versus-host disease (GVHD). In GVHD, the donor white blood cells react against the patient's normal tissues. GVHD can be mild or very severe, and often affects the liver, skin, or digestive tract. GVHD can occur at any time after the transplant, even years later. Steroids or medications that suppress the immune response may be used to treat this complication.
Because many of the treatments for leukemia deplete normal blood cells, increasing the risk for bleeding and infection, supportive treatments may be needed to help prevent these complications of treatment. Supportive treatments may also be needed to help minimize and manage unpleasant side effects of medical or radiation therapy.
Types of supportive and preventive treatments that can be used for patients undergoing treatment for leukemia include the following: Vaccines against the flu or pneumonia Blood or platelet transfusions Anti-nausea medications Antibiotics or antiviral medications to treat or prevent infections.
White blood cell growth factors to stimulate white blood cell production ( such as granulocyte-colony stimulating factor [G-CSF], made up of filgrastim [Neupogen] and pegfilgrastim [Neulasta] and granulocyte macrophage-colony stimulating growth factor [GM-CSF], made up of sargramostim [Leukine] ).
Red cell growth factors to stimulate red blood cell production ( darbepoetin alfa [Aranesp] or epoetin alfa [Procrit] ) Intravenous injections of immunoglobulins to help fight infection.
