Hematology and Blood Disorders

Immunohematology is a division of hematology and transfusion medicine which studies antigen-antibody reactions and analogous phenomena as they relate to the pathogenesis and clinical manifestations of blood disorders. The maven Immunohematology and Transfusion Physician provides expert opinion for difficult transfusions, massive transfusions, incompatibility work up, therapeutic plasmapheresis, cellular therapy, irradiated blood therapy, leuko reduced and washed blood products, stem cell actions, platelet rich plasma therapies, HLA and cord blood banking. Immunohematological tests enable safe blood transfusion and transplantation of haematopoietic tissue, as well as avoid undesired immune-related phenomena after transfusion, transplantation and during pregnancy. 

Hemoglobin is a red protein responsible for transferring oxygen in the blood of vertebrates. Its molecule comprises four subunits; each holding an iron atom bound to a haem group. Iron plays an important role in hemoglobin production. A protein named transferrin binds to iron and transports it throughout the body. This helps body make red blood cells, which contain hemoglobin.
In Human, Iron metabolism is the set of chemical reactions that conserve human homeostasis of iron at the systemic and cellular level. Iron is both essential to the body and potentially toxic. Regulating iron levels in the body is a critically important part of many aspects of human health and disease. 
 

COVID-19 is a systemic disease with a significant impact on the hematopoietic system and hemostasis. Patients with cancer may be huge susceptible to and have higher morbidity and mortality rates from COVID-19 than the general population, while epidemiologic data specifically addressed to hematologic patients are limited. The prevalence of COVID-19 in hematologic patients, mostly affected by malignancies, was not significantly higher compared to that of the general population. The revision enlightens on the epidemiology, risk factors and outcomes of COVID-19 among patients with HM. While the COVID-19 vaccinations will lead to a marked reduction of infections in HM patients, the possibility of a lower efficacy of vaccinations needs to be taken into account and possibly resembling previous experiences with influenza vaccination. 

Anemia is a condition in which there is a lack of red cells or of hemoglobin in the blood, resulting in pallor and weariness.  The main cause of anemia is low levels of iron in the body, so it is also called as iron-deficiency anemia. Human body needs a certain amount of iron to make hemoglobin, the substance that moves oxygen throughout your body. Whereas anemia causes a symptom like

• Wooziness, lightheadness, or feeling like you are about to pass out
• Fast or unusual heartbeat
• Headache
• Pain, including in your bones, chest, belly, and joints
• Complications with growth, for children and teens
• Shortness of breath
• Skin that's pale or yellow

Bone Marrow Transplantation is a medical treatment that replaces your bone marrow with healthy cells. The replacement cells can either originate from your own body or from a donor. Bone Marrow Transplantation is also called as stem cell transplant or hematopoietic stem cell transplant. Transplantation can be mainly used to treat certain types of cancer, such as

• leukemia
• myeloma
• lymphoma
• immune system diseases that distress the bone marrow

Chemotherapy is pharmacological treatments that use to destroy fast-growing cells in your body. And most often used to treat cancer, since cancer cells grow and multiply much more rapidly than most cells in the body.

Treatment that uses drugs to avoid the growth of cancer cells, either by killing the cells or by stopping them from dividing. Whereas Chemotherapy, also called “chemo,” is treatment with drugs that block or slow down cell growth, most often for cancer. 

A hematology nursing are specializes in caring for patients who are dealing with blood-related illnesses, diseases, or disorders such as

• Cancer
• Hemophilia
• Hodgkin‘s disease
• Leukemia
• Lymphoma
• Myeloma
• Sickle cell anemia

These nurses are responsible for execution check-ups, collecting blood samples, ordering blood tests, initiating IVs, administering medications, assisting with blood transfusions, operating medical machinery, and providing medical care and treatment to patients who are dealing with a variety of illnesses.

Hematology nurses look after and inspect conditions that are associated with blood problems and also bone marrow problems, which is the factory where all the blood cells are made. 

Neuro-hematology is study of the variations in the composition of the blood occurring in diseases of the nervous system.
A wide spectrum of hematologic disorders causes the central and peripheral nervous system. These disorders include like

• Porphyria
• Thrombotic thrombocytopenic purpura-hemolytic uremic syndromes
• Sickle cell disease
• Plasma cell dyscrasias
• Monoclonal gammopathy
• Primary systemic amyloidosis
• Primary systemic amyloidosis
• Waldonstrom’s macroglobulinemia
• Myeloproliferative syndromes
• Cryoglobulinemia, and polycythemia vera

Some, like porphyria, cause both central and peripheral nervous system manifestations containing sensory/motor peripheral neuropathy, dysautonomia, pain, seizures, and abdominal pain.
Others such as sickle cell disease primarily affect the brain and cause both clinically apparent strokes associated with a vasculopathy of large intracranial blood vessels, as well as a smaller amount obvious micro strokes that cause progressive cognitive decline if not treated. 

Leukemia is a malignant progressive disease in which the bone marrow and other blood-forming organs produce numbers of immature or abnormal leucocytes. These suppress the production of normal blood cells, foremost to anemia and other symptoms. Leukemia is malignant tumor of the white blood cells. White blood cells (also called leukocytes or WBCs) fight infections and additional diseases. In leukemia, the bone marrow (spongy material inside the bones) makes several white blood cells that aren't normal. These abnormal WBCs gather the bone marrow and get into the bloodstream.

Whereas blood cancer that initiates in blood-forming tissue, such as the bone marrow, or in the cells of the immune system and it affect the production and function of blood cells.  Maximum blood cancers, the normal blood cell development process are interrupted by uncontrolled growth of an abnormal type of blood cell. These abnormal blood cells, or cancerous cells, inhibit blood from performing many of its functions, like fighting off infections or preventing serious bleeding. 

Transfusion medicine is a multidisciplinary science apprehensive with the proper use of blood or blood products in the treatment or prevention of disease. Whereas it is Division of medicine that includes all aspects of the transfusion of blood and blood components including aspects related to hemovigilance. It contains issues of blood donation, immunohematology and other laboratory testing for transfusion-transmitted diseases, management and monitoring of clinical transfusion practices, patient blood management, therapeutic apheresis, stem cell collections, cellular therapy, and coagulation. 

The word hemoglobinopathy refers to a number of inherited disorders that result from mutations in the globin (alpha, beta, or gamma) genes. These mutations result in either condensed production or altered structure of the hemoglobin (Hb) molecule.
The hemoglobinopathies are a group of disorders delivered down through families (inherited) in which there is abnormal production or structure of the hemoglobin molecule. This group of disorders includes

• Hemoglobin C disease
• Hemoglobin S-C disease
• Sickle cell anemia
• Thalassemias

Many blood disorders take their name from the element of the blood they impact.
The following types are blood disorders that affect a decrease in blood components or affect their function:

• Leukemia: A group of cancers that affect the blood and bone marrow, leading to abnormal white blood cell production. Research in leukemia encompasses various aspects such as understanding the genetic mutations driving the disease, developing targeted therapies, and improving treatment outcomes.
• Sickle Cell Disease (SCD): Sickle cell disease is a genetic disorder affecting hemoglobin production, leading to abnormal red blood cells. Research in sickle cell disease focuses on finding new treatments to alleviate symptoms, prevent complications, and ultimately cure the disease through approaches like gene therapy and stem cell transplantation.
• Hemophilia: Hemophilia is a genetic bleeding disorder characterized by a deficiency in clotting factors. Research in hemophilia aims to improve clotting factor replacement therapies, develop gene therapies to correct the underlying genetic defects, and explore novel treatment modalities like gene editing.
• Thalassemia: Thalassemia is a group of inherited blood disorders involving abnormal hemoglobin production. Research in thalassemia focuses on developing better supportive care strategies, such as blood transfusions and iron chelation therapy, as well as exploring curative approaches like gene therapy and bone marrow transplantation.
• Myelodysplastic syndromes (MDS): Myelodysplastic syndromes are a group of disorders characterized by dysfunctional blood cell production in the bone marrow. Research in MDS involves understanding the underlying biology of the disease, identifying prognostic markers, and developing targeted therapies to improve patient outcomes.
• Immune thrombocytopenic purpura (ITP): ITP is an autoimmune disorder characterized by low platelet counts due to immune-mediated destruction of platelets. Research in ITP focuses on elucidating the mechanisms of autoimmune dysregulation, developing novel immunomodulatory therapies, and optimizing treatment strategies to achieve durable remission.
• Leukopenia: Leukopenia is a decrease in the number of white blood cells, impairing the body's ability to fight infections and increasing susceptibility to illness.
• Thrombocytopenia: Thrombocytopenia is a condition characterized by a low platelet count in the blood, leading to an increased risk of bleeding and bruising.

Types of blood disorders that increase blood components are:

• Erythrocytosis – if the disorder includes red blood cells
• Leukocytosis – if the disorder causes white blood cells
• Thrombocythemia or thrombocytosis – if the disorder distresses platelets

Acute lymphocytic leukemia (ALL) and chronic lymphocytic leukemia (CLL) are two kinds of blood cancer that affect specific white blood cells produced by the bone marrow, called lymphocytes. ALL is also termed as acute lymphocytic leukemia.
CLL is the most common form of leukemia cancer distressing adults. ALL primarily causes children, although it can occur in adults. Both acute lymphocytic leukemia and chronic lymphocytic leukemia produce comparable symptoms, including:

• Fatigue and weakness
• Fever
• Night sweats
• Frequent infractions
• Easy bruising and bleeding
• Weight loss
• Swollen lymph nodes
• Abdominal fullness

The most frequently used test to diagnose blood disorders is the complete blood count. The CBC gazes at the three types of blood cells and determines if any are increased or decreased or if more than one blood cell is affected. A blood smear may also be contained with the CBC, with a microscopic examination to provide additional helpful information. For bleeding or clotting problems, mostly physician will likely order coagulation blood tests, which include the prothrombin time (PT) and the partial thromboplastic time (PTT).

Treatment is determined by specific diagnosis. Some chronic blood disorders have no particular treatment but may require treatment during acute events. For example:

• Anemia caused by iron deficiency will be cured with iron supplementation. Beta thalassemia major, an organic form of anemia, is treated with monthly blood transfusions.
• Hemophilia can be treated with coagulation factor replacement products that can be used to treat individual bleeds or, when given on a regular basis, prevent bleeds (prophylaxis).
• Polycythemia Vera is treated by phlebotomy—representation a pint of blood intermittently to keep the number of red cells from dropping below the dangerous level.
• Blood clots may be cured with anticoagulant therapy (blood thinners). Some cases may require catheter-directed thrombolysis to melt the blockage.
• Thrombocythemia may be cured with aspirin or might require medications such as hydroxyurea, interferon Alfa, or anagrelide (rarely used).
• Immune thrombocytopenia might be treated with corticosteroids such as prednisone or medications that increase the platelet count. Eliminating the spleen is another treatment performed when needed

A hematologist oncologist is a medic who specializes in dealing with cancer of the blood. They have additional training in the blood system, lymphatic system, bone marrow, and cancers.
The word “hematologist oncologist” comes from two different types of clinicians. Hematologists focus in diagnosing and treating blood diseases. Oncologists specialize in make a diagnosis and treating cancers. Whereas hematologist oncologist specializes in both. Hematology-oncology contains such diseases as

• Iron deficiency anemia
• Hemophilia
• Sickle cell disease
• Thalassemias
• Leukemia
• Lymphomas

Veterinary hematology is extremely interesting, because there are marked species differences in hematopoietic cells. For example, birds, amphibians and reptiles have nucleated erythrocytes and platelets (called thrombocytes), which makes assessment of their blood far more challenging than those of mammals.

Subsequently animals cannot speak for themselves; we use their blood as a window into their bodies. Abnormalities in the blood can afford clues as to the presence of underlying disease (e.g. inflammation) and can be diagnostic in it, e.g. can reveal leukemia.

The vascular bleeding disorders are a heterogeneous group of conditions characterized by tranquil bruising, petechiae, ecchymosis, and mucosal and spontaneous bleeding from lesser vessels. The primary defect lies either in the vessels themselves or the perivascular connective tissue (eg, pseudoxanthoma elasticum, osteogenesis imperfecta, Marfan syndrome). Hemorrhage may be a protuberant feature of scurvy or of immunoglobulin A–associated vasculitis, a hypersensitivity vasculitis common during childhood.
Vascular defects affecting abnormal bleeding are rare. In cases of vitamin C deficiency (scurvy), capillary integrity is absent, and blood seeps into the tissues. In the organic condition hemorrhagic telangiectasia, groups of enormously dilated capillaries can be seen in the skin and mucous membranes of the mouth, nose, and gastrointestinal and respiratory tracts. The lesions look like in adult life and tend to bleed on the least provocation. Ehlers-Danlos syndrome is a disorder of collagen synthesis in which the enlarged fragility of vessels causes them to be easily ruptured. The use of cortisone, prednisolone, and additional glucocorticoid drugs are associated with increased capillary fragility and purpura (pinpoint hemorrhages in the skin and mucous membranes).

In a cord blood transplant, stems cells are composed from umbilical cord blood. Umbilical cord blood is the blood not there in the umbilical cord after a baby's birth. The cord blood can be frozen and kept until it's used in a cord blood transplant. Cord blood is a process of collecting potentially life-saving stem cells from the umbilical cord and placenta and storing them for forthcoming use. Stem cells are immature cells that can undertake the form of other cells
 The purpose of Cord blood is, it encloses cells called hematopoietic stem cells. These cells can crack into any kind of blood cell and can be used for transplants that can cure diseases such as blood disorders, immune deficiencies, metabolic diseases, and some kinds of cancers.

Hemostasis is the mechanism that indicates to cessation of bleeding from a blood vessel. It is a process that contains multiple interlinked steps. This cascade culminates into the development of a “plug” that closes up the damaged site of the blood vessel controlling the bleeding. It is the procedure of stopping or arresting bleeding or keeping the blood within the damaged blood vessel, particularly by physiological means such as vasoconstriction and coagulation or by surgical means.

The thrombosis is a formation or occurrence of a blood clot in a blood vessel. The vessel may be any vein or artery as, for instance, in a deep vein thrombosis or a coronary (artery) thrombosis. The clot itself is characterized a thrombus. If the clot breaks unattached and travels through the bloodstream, it is a thromboembolism. Thrombosis, thrombus, and the prefix thrombo- all arise from the Greek thrombo meaning a lump or clump, or a curd or clot of milk.

Genome editing technologies enable scientists to make variations to DNA, leading to changes in physical traits, like eye color, and disease risk. Scientists use different equipment to do this. These technologies behave like scissors, cutting the DNA at a particular spot. Then scientists can eliminate, add, or replace the DNA where it was cut.

Cellular therapy (CT) is the replacement of human cells to replace or repair broken tissue and/or cells. With new technologies, innovative products, and unlimited imagination, many different types of cells may be used as part of a therapy or treatment for a variety of diseases and conditions. 

Myelodysplastic is a type of cancer in which the bone marrow does not make enough well blood cells (white blood cells, red blood cells, and platelets) and there are abnormal cells in the blood and/or bone marrow. When there are rarer healthy blood cells, infection, anemia, or bleeding may occur.
Myeloproliferative is a type of disease in which the bone marrow makes too several red blood cells, platelets, or certain white blood cells. There are several kinds of myeloproliferative disorders

• Polycythemia Vera
• Essential Thrombocythemia
• Primary myelofibrosis
• Chronic myelogenous leukemia

A Pediatric hematologist is treating with blood disorders and cancers in children, teens, and young adults. Childhood cancers are matchless type of cancers, the etiology of which is uncertain however majority of these cancers are curable. Common cancers seen in childhood contain Acute Leukemia (Blood cancers), solid tumor like neuroblastoma, Wilms’ Tumor and Brain tumors. The cure rates of these cancers have increase from less than 10% survival in 1960’s to > 90% survival in the present age. Outcome of childhood cancers is one of the most remarkable amongst all cancers across age groups put together provided these cancers are diagnosed early and treated appropriately. 

Biomarker is a measurable meter of the severity or presence of some disease state. More generally a biomarker can be used as an indicator of a physiological state or a specific disease of an organism. Biomarkers in hematology are useful to identify or diagnose blood diseases in animals.
Cancer biomarkers are biological molecules formed by the body or tumor in a person with cancer. Biomarker testing helps describe alterations in the tumor. Biomarkers can be DNA, RNA, protein or metabolomics profiles that are definite to the tumor. 

Clinical Hematology is division of clinical medicine which deals with diagnosis and treatment of blood disorders and blood cancers. Clinical hematology is dedicated to the diagnosis and treatment of diseases of blood and blood making tissues. The diseases in the area of Hematology may contains: Blood cells (red blood cells, white blood cells and platelets); other blood components; the hematopoietic organs (bone marrow, lymph nodes, spleen). 

Cancer that starts in blood-forming tissue, such as the bone marrow, or in the cells of the immune system. For instance of hematologic cancer are leukemia, lymphoma, and multiple myeloma. Also called blood cancer. Hematologic Cancers occurs  smoking, radiation exposure, and exposure to chemicals such as benzene (a widely used industrial chemical) have all been linked to increased risk of some types of blood cancers. Some more risk factors like
Epstein-Barr virus,
HIV
Human T-cell lymphoma/leukemia virus infections