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What is Hematology?

Hematology concerns the study of blood, the blood-forming organs and blood diseases. Hematology also includes

the diagnosis, treatment, prognosis and prevention of blood diseases, such as lymphoma and leukemia. Dr. Vijay

Ramanan is a certified hematologist in Medical Oncology and Hematology.

Hematologists may specialize further or have special interests, for example in:

treating bleeding disorders such as hemophilia and idiopathic thrombocytopenic purpura

treating hematological malignacies such as lymphoma and leukemia treating hemoglobinopathies

in the science ofblood transfusion and the work of a blood bank

in bone marrow and stem cell transplantation

(Hematology comes from the Greek words (''haima'') meaning "blood" and

(''logos''), a root commonly employed to denote a field of study.)

At the Ruby Hall Clinic Oncology & Hematology Clinic we work to formulate a diagnosis and deliver

the most appropriate therapy if needed for blood diseases. Hematology is a distinct subspecialty of

internal medicine, and overlaps with the subspecialty of medical oncology, so we are uniquely

trained to deliver the proper treatment.

LYMPHOMA

Lymphoma is not a single cancer but a group of many related cancers--there are nearly

30 different types of lymphoma. Broadly, they are grouped under two categories: Hodgkin

Disease and Non-Hodgkin Lymphoma. These two broad groups may be similar in their symptoms

and the tests that are required, but they behave differently when they affect a person. Today,

primary treatment cures more than 80 percent of patients and significant emphasis is now placed

on survivorship. The most recent advance in Hodgkin lymphoma management has come from

diagnostic imaging using FDG-PET scans, which are more specific for tumor identification than CT

scans.

While the exact causes of lymphoma remain unknown, the following factors increase the risk: older

age, being male, of Caucasian race, HIV/AIDs, diet high in meats and fat and exposure to certain

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pesticides. Symptoms of lymphoma include swollen lymph nodes in the neck, underarms and groin,

fever, weakness and fatigue, weight loss, sweating, difficulty in breathing or chest pain, itchy skin

and rash.

To begin treatment, we will perform a lymph node biopsy to diagnose lymphoma. Additional tests

are then conducted to determine the stage (extent) of the lymphoma including blood tests, bone

marrow biopsies, and imaging tests, such as a CT scan or PET scan. Imaging tests show whether

the lymphoma has spread to other parts of your body, like the spleen and lungs. Decisions about

treatment are then determined by your doctor, who will consider your age, general health, and

stage and type of lymphoma. Hodgkin lymphoma is one of the most curable types of cancer.

Treatment options include the following:

Chemotherapy

Chemotherapy and radiation that directly targets the lymphoma

Biological therapies, such as antibodies, directed at lymphoma cells

Stem cell transplant

For some patients, participating in a clinical trial provides access to experimental

therapies. If you are diagnosed with lymphoma, talk with your doctor about whether

joining a clinical trial is right for you.

LEUKEMIA

Leukemia is a type of cancer found in your blood and bone marrow and is caused by the rapid

production of abnormal white blood cells. These abnormal white blood cells are not able to fight

infection and impair the ability of the bone marrow to produce red blood cells and platelets.

Leukemia can be either acute or chronic. Chronic leukemia progresses more slowly than acute

leukemia, which requires immediate treatment. Leukemia is also classified as lymphocytic or

myelogenous. Lymphocytic leukemia refers to abnormal cell growth in the marrow cells that become

lymphocytes, a type of white blood cell that plays a role in the immune system. In myelogenous

leukemia, abnormal cell growth occurs in the marrow cells that mature into red blood cells, white

blood cells, and platelets. There are four broad classifications of leukemia:

Acute lymphocytic leukemia (ALL)

Acute myelogenous leukemia (AML)

Chronic lymphocytic leukemia (CLL)

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Chronic myelogenous leukemia (CML)

Leukemia occurs in both adults and children. ALL is the most common form of childhood leukemia,

and AML is the second most common. The two most common adult leukemias are AML and CLL.

Although experts are uncertain about the causes of leukemia, they have identified several risk

factors that include the following:

Exposure to high levels of radiation

Repeated exposure to certain chemicals (for example, benzene)

Chemotherapy

Down Syndrome

A strong family history of leukemia

Symptoms vary depending on the type and stage of leukemia, but they can include the following:

Fever, chills, night sweats and other flu-like symptoms

Weakness and fatigue

Swollen or bleeding gums

Headaches

Enlarged liver and spleen

Swollen tonsils

Bone pain

Paleness

Pinhead-size red spots on the skin

Weight loss

Your doctor will conduct a complete blood count (CBC) to determine if you have leukemia. This test

will reveal if you have leukemic cells, or abnormal levels of white blood cells; both are signs of

leukemia. Abnormally low red blood cell or platelet counts can also indicate leukemia. If you test

positive for leukemia, your doctor will perform a biopsy of your bone marrow to determine which

type you have.

Treatment depends on your age, general health, and type of leukemia. You might receive a

combination of treatments that could include chemotherapy, biological therapy, radiation therapy,

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and stem cell transplantation. Patients with acute leukemia often undergo chemotherapy because

this type of treatment targets fast-dividing cells. Many acute leukemia patients have responded

successfully to treatment. On the other hand, because the cells divide more slowly in chronic

leukemia, it is better treated with targeted therapies that attack slowly dividing cells as opposed to

traditional chemotherapy that targets rapidly dividing cells.

For some patients, participating in a clinical trial provides access to experimental therapies. If you

are diagnosed with leukemia, talk with your doctor about whether joining a clinical trial is right for

you.

Because the cause of leukemia remains unknown, there is no certain way to prevent it. However,

avoiding exposure to solvents, such as benzene and toluene, and unnecessary exposure to x-rays is

generally good practice. If you think you may be exhibiting signs of leukemia, being aware of the

risk factors and symptoms and talking with your doctor are critical to early diagnosis and treatment.

It is especially important for people who have a family history of leukemia to be aware of symptoms

and share their family medical history with their doctors.