Which doctor examines the blood. Hematologist: who is it and what does it treat. All about the medical specialty hematologist

Hematologist is a therapist who specializes in blood diseases. He is also involved in the prevention, treatment and study of these diseases.

What does a hematologist do?

His competence includes that part of medicine that is devoted to the features of the structure and functioning of the circulatory system, that is, blood, its organs, the causes and methods for determining blood diseases, methods for preventing such diseases.

What diseases does a hematologist treat?

The most common blood disorder is anemia. With this disease, the level of hemoglobin and red blood cells decreases. The nature of this disease is different, but most often it occurs due to a lack of iron, so it is called iron deficiency anemia.

Iron plays an important role in the creation of hemoglobin in the building erythrocytes in the bone marrow. Iron is present in the form of myoglobin protein in muscle tissue, it is in the cells of respiratory enzymes. If there is not enough iron, there is a violation of many metabolic functions.

Iron deficiency is often seen in children under two years of age. It depends both on the characteristics of the development of the fetus, and on the formation of the child's body up to a year. An insufficient amount of iron can be even before the baby is born, when the mother experiences a severe degree of toxicosis during pregnancy, if the mother has diseases in the chronic stage, and especially if the pregnant woman has a lack of iron or she adheres to vegetarianism. There may also be insufficient iron in children who were born twins, triplets or prematurely, since the child takes iron in the last three months of gestation.

Having been born, especially up to a year, the growth of the child increases quite quickly. Within a year, his weight is three times his birth weight, the amount of blood becomes 2.5 times more.

For this reason, the need for iron is growing. This is where complications come in. Iron can only be obtained through food.

Food products have a different content of iron, for example, it is not enough in milk. A child up to a year is fed mainly with milk, so these children have a lack of iron.

However, a child up to a year is under the supervision of parents, regularly visits the clinic. Therefore, deviations in the behavior and health of the baby, pallor of the skin, as a rule, are noticed on time and are perfectly treated with iron-containing preparations. An important role is given to normal nutrition, it is necessary to add complementary foods, juices containing vitamins in time.

If you replenish the lack of iron in a timely manner, the child will get rid of anemia.

It is worth talking about another category of children who quite often suffer from a lack of iron in the body - these are girls in the puberty period, when the body is rebuilt, and there is a sharp jump in iron consumption. Diagnosis in such cases, as a rule, is late. Iron deficiency is observed for a long time, and as a result, a whole complex of symptoms of chronic anemia develops. These include: fatigue, drowsiness, poor appetite. A sick child may not tolerate the taste, smell of fish and meat, but with appetite there are cereals and chalk. The skin becomes dry, hair and nails break. Changes in the state of the mucous membrane of the mouth and larynx are observed, the process of swallowing may even be disturbed.

Girls also begin their menstrual cycle during puberty. If at the same time there are violations of the formation of platelets, menstruation can be long and plentiful. It can also lead to the development of iron deficiency.

Iron deficiency also appears during non-intense, but prolonged bleeding. This may be due to a violation of the gastric mucosa and other internal organs. The cause can be such diseases: hernias, polyps, tumors, ulcers and other diseases of the gastrointestinal tract.

In order for a child who has iron deficiency anemia due to chronic blood loss to recover, the disease that caused the bleeding must be treated. Often this happens during surgery. This is the only way to restore iron deficiency and recover from anemia.

Hemolytic anemia

The next most common type of anemia is hemolytic anemia. With this disease, a normal number of red blood cells is formed in the bone marrow, but for some reason they do not live long, and soon they are destroyed.

Hemolytic anemia is usually hereditary. But heredity can be different. Everything in the body is controlled by two genes: one gene is considered dominant, the second is considered secondary. The main one is called a disease in which one gene is sick, but it dominates and forms the disease, and the second - the secondary one is healthy. The disease is in a recessive form, when there is control by two minor genes, which are both unhealthy and have the same negative information. Hereditary recessive diseases are severe and difficult to treat. An inherited form of hemolytic anemia that is common is called microspherocytic hemolytic Minkowski-Choffard anemia. It is inherited according to the dominant type, while a violation of genetics is observed in the erythrocyte membrane.

Iespherocytic hemolytic anemia is much less common. It is inherited in a recessive form, the disease is difficult. In this type of anemia, cells are rapidly destroyed due to a congenital lack of an enzyme present in red blood cells.

As a result, with the disease of hemolytic anemia, red blood cells do not live long.

If Minkowski-Choffard anemia is observed, the destruction of red blood cells occurs in the spleen. In this organ, the destruction of old cells that have already worked out, even in a healthy state of the body, is carried out.

Nonspherocytic hemolytic anemia - cells are destroyed wherever there are macrophages that can detect red blood cells that are subject to change. For example, this can occur in such organs: liver, bone marrow.

The main characteristics of all types of hemolytic anemias are:

• pale skin;
• jaundice;

These patients are painfully pale, from time to time their condition worsens, the temperature increases, pallor, yellowness of the skin intensifies. This means that the disease has worsened - this is a hemolytic crisis. At this time, the patient is given special treatment, often a blood transfusion.

Minkowski-Choffard anemia is also treated surgically. At the same time, the spleen is removed as an organ that is responsible for the rapid destruction of red blood cells. In the event that the Minkowski-Choffard disease passes easily, crises are rare, but after a while cholelithiasis may appear. By removing the spleen, the patient is guaranteed recovery. There is a normalization of the composition of the blood, jaundice disappears, stones do not form in the gallbladder. But at the same time, a genetic feature remains, which is inherited. If the parent has undergone surgery, there is still the possibility of transmitting hemolytic anemia to the child.

Nonspherocytic hemolytic anemia not often found. Based on the fact that red blood cells are destroyed in several organs, removal of the spleen is not effective. In this type of anemia, the destruction of erythrocytes is independent of bone marrow dysfunction.

With Minkowski-Choffard anemia, there is an insufficient supply of iron or its loss during bleeding. The cause of non-spherocytic hemolytic anemia is genetic disorders in the erythrocyte, which does not live long and is quickly destroyed both in the spleen and in other organs.

hypoplastic anemia

In hypoplastic anemia, primary damage to the bone marrow occurs. In this case, the process of hematopoiesis is disrupted. With this disease, all hematopoiesis is affected, both leukocytes and platelets. In the blood, the level of leukocytes, erythrocytes and platelets is underestimated, in the bone marrow there is an increased level of adipose tissue.

Hypoplastic anemia can be congenital or acquired. The congenital form is Fanconi anemia. There is a hematological disorder against the background of congenital bone diseases. Hypoplastic anemia can manifest itself in the form of the birth of a child with extra fingers, or a lack of them, slow growth, a small head size, and a row of teeth is incorrectly formed. At 5-6 years of age, hematological anemia occurs.

There are also a partial form of anemia, in which there is a violation of the system of education in the blood of leukocytes, erythrocytes and thrombophlebitis. The disease is found in infancy, it is difficult.

aplastic anemia

A special type is aplastic anemia, when it is difficult to identify the cause of the disease.

It is believed that the disease depends on damage to the original bone marrow stem cell. From this cell, blood is formed in various directions: infectious, toxic or immune influence.

The disease occurs abruptly, the state of health becomes worse, there is a strong pallor of the skin, bruises, various bleedings appear, the temperature may rise.

Aplastic anemia is a serious disease that develops rapidly and, if left untreated, the outcome can be tragic.

What organs does a hematologist treat?

• Blood.
• Spleen.
• Bone marrow.

VIDEO

When should you contact a hematologist?

With blood diseases, there is poor health, weakness, rapid fatigue, poor appetite. Therefore, such indications can be attributed to the first signs of diseases associated with impaired hematopoiesis. In case of changes in the child's well-being, it is imperative to contact a specialist.

In particular, it is worth worrying when the child's skin becomes pale with a yellow tint, bruises appear,.

With blood diseases, a child can talk about pain in the bones, joints, and spine. There may be a headache, and in the abdomen.

Many visits to a hematologist due to enlarged lymph nodes, which are responsible for protecting the body. They prevent the spread of the disease and often perform this function on their own, while their inflammation occurs. Lymph nodes increase in size and become painful. Inflammation is especially pronounced in children under 7 years of age, when an infection enters the body. Up to two years, this protective function of the lymph nodes in children is not so intense. In this case, the infection enters the bloodstream, bypassing the lymphatic barrier, and spreads throughout the body, the disease becomes generalized. At an older age in children, as in adults, the fight against infections in the lymph nodes occurs invisibly, symptoms do not appear.

As a rule, inflammation occurs in those lymph nodes that are closest to the source of infection. For example, the lymph nodes that are located under the jaw become inflamed due to infection in the mouth and throat due to caries, stomatitis, tonsillitis. The disease, called cat scratch, is characterized by inflammation of the gland, which is located near the site of the scratch. Childhood diseases like rubella, measles, infectious mononucleosis and other viruses manifest themselves in inflammation of the lymph nodes located on the back of the neck.

When and what tests should be done?

To diagnose anemia, the following tests are needed:

• (reticulocytes);
• percentage of transferrin;
• ferritin content;
• iron-binding index.

What are the main types of diagnostics carried out by a hematologist?

Currently, the following methods are widely used to diagnose blood diseases:

• ultrasound diagnostics;
• CT scan;
• nuclear magnetic resonance.

These diagnostic methods provide an opportunity to determine the size and structural parameters of organs, all kinds of bone diseases, find tumors in different locations.

The diagnosis of leukemia made by doctors can really shock both the child and the parents.

• Become familiar with all the information that is available about the type of leukemia diagnosed by your doctor. Learn treatments. Awareness will help in choosing a method of healing;
• Don't get depressed. Eat right, get plenty of rest and exercise. This will give an improvement in overall well-being;
• Meet with other patients or families affected by leukemia. Check with your healthcare provider about the location of an appropriate support group in your area. In addition, you can search for people on the Internet who are also concerned about this disease.

Scientists at the Mayo Hospital in Minnesota in America have found that the antioxidants found in green tea can kill cancer cells and reduce the effects of cancer. This was reported in the publishing house "Telegraph". Since the 1970s, doctors have been researching the anti-cancer abilities of green tea and have determined that in countries where people consume green tea a lot, the incidence of cancer is lower. In 2004, laboratory studies were carried out on mice, which confirmed that the antioxidants found in green tea can destroy cancer cells in leukemia. Evidence also suggests that it will be equally effective in patients with chronic lymphocytic leukemia, which is the best-known type of leukemia.

Doctors attribute to sick patients an extract of green tea - 400-2000 mg twice a day. Many patients have noticed that the size of the lymph nodes has decreased by half or more. According to experts, green tea can make the patient's condition stable in the early stages of leukemia, and also lead to a slowdown in the spread of the disease.

If you have concerns, questions, or need to see a hematologist, you can make an appointment with a hematologist. Our clinic will provide you with any services. Experts will examine, give advice, and help, make a conclusion. In addition, you have the opportunity to make a call to a specialist hematologist at home. The clinic is open 24 hours a day.

In the event that you have previously performed any examinations, you must take them with you to an appointment with a hematologist. If studies have not been carried out, our clinic will do everything necessary to make the correct diagnosis.

Remember to take care of your health. There are many diseases whose symptoms are not noticed at first, but in the end it may turn out that it is too late to start treatment. To avoid this, you should be examined by a hematologist several times a year. This will stop a terrible disease, as well as maintain spiritual and physical health.

If you have questions that need to be resolved, use online consultations, this will give you the opportunity to find answers to your questions and get acquainted with the recommendations of a hematologist on how to take care of your health.

The competence of a hematologist doctor includes questions on the sections of medicine regarding the functions and structure of blood systems (directly blood, hematopoietic organs and blood destruction), the causes of the development of diseases of the circulatory system. Also, a hematologist is developing methods for recognizing these diseases, finding ways to treat and prevent them.

What diseases should be consulted with a hematologist?

1. Iron deficiency anemia

Anemias are the most common diseases of the hematopoietic system. If the number of red blood cells and hemoglobin is reduced in blood counts, it is worth talking about anemia. The concept of anemia includes diseases that have a different etiology, but mostly all of them are associated with a lack of iron.

At the appointment, the hematologist will tell you that when building hemoglobin in the maturing erythrocytes of the bone marrow, iron metabolism is of decisive importance. Iron is found in the muscles, and is also part of the respiratory cellular enzymes. In case of iron deficiency, many metabolic processes in the body begin to work with disturbances. In particular, iron deficiency anemia is more often dealt with by a hematologist for children, since this disease mainly occurs in children under the age of two years.

2.Hemolytic anemia

Hemolytic anemias are the second most common disease reported by a hematologist.

In hemolytic anemia, the bone marrow produces a sufficient number of red blood cells, but due to various circumstances, they have a short life expectancy and are subject to rapid destruction.

At the consultation, the hematologist will tell you that, most often, the causes of hemolytic anemia are a congenital or hereditary factor, about its types, in particular about recessive or dominant anemia, that recessive anemia usually has a much more severe course and serious consequences. According to the reviews of hematologists, the most common type of hereditary hemolytic anemia is Minkowski-Choffard disease, which is inherited according to the dominant type.

3. Hypoplastic anemia

Hypoplastic anemia is directly related to the onset of the process of destruction of the bone marrow and the violation of the process of hematopoiesis. In general, the name of the disease does not fully reveal its essence, since in this case we are talking not only about anemia, but also about the defeat of all hematopoietic organs, including those that produce platelets and leukocytes.

According to hematologists, hypoplastic anemia can be acquired or congenital. The most common congenital form of the disease is Fanconi anemia. Its peculiarity lies in the fact that hematological disorders occur in combination with other congenital malformations, mainly from the skeletal system.

4. Aplastic anemia

Aplastic anemias represent a special group of diseases, the cause of which can be very difficult to establish. The disease is associated with damage to the ancestral stem cell of the bone marrow, from which, in fact, hematopoiesis occurs in various directions. The disease begins acutely, the patient's condition deteriorates sharply, severe pallor, bruising and bleeding appear. With this disease, an urgent consultation with a hematologist and immediate treatment are necessary, otherwise the disease has an unfavorable prognosis.

When do I need to see a hematologist?

With blood diseases, patients often experience general malaise, loss of appetite, weakness, fatigue. Often such complaints are symptoms of serious diseases associated with disruption of the bone marrow and hematopoietic system. Therefore, if there are such complaints in children, parents should urgently contact a pediatric hematologist. Especially parents should be wary of the presence of pale skin in a child, sometimes with an icteric tinge, with the appearance of nasal or other bleeding, bruising under the eyes.

An appointment with a hematologist is necessary if the child complains of pain in the bones, spine and joints, as well as abdominal pain and headaches.

If the child often has a nosebleed, increased drowsiness and weakness, inattention, irritability, decreased appetite, then you need to contact the local pediatrician, who will refer the patient to a general blood test and, based on the results of the analysis, you may need to consult a hematologist.

If the child has enlarged lymph nodes, then it is necessary to contact the local pediatrician, as well as consult a surgeon, a phthisiatrician, take a general blood test, do an ultrasound of the abdominal organs and an X-ray of the chest organs. Based on the results of the study, the pediatrician may refer the patient to a pediatric hematologist.

It is important to know that in no case should you start taking iron supplements on your own, and replacing iron with food is impossible.

According to reviews, hematologists are most often treated for enlarged lymph nodes. Lymph nodes in the body perform protective functions and prevent the spread of diseases throughout the body, which often manifests itself in their increase and increased soreness. This is especially noticeable in preschool children. In older children and adults, suppression of the disease in the lymph nodes is more often completely asymptomatic.

Diagnosis of anemia

To diagnose anemia, a hematologist will refer the patient to the following tests:

• Complete blood count with reticulocytes;
• Ferritin;
• Percentage of transferrin saturation;
• Iron-binding ability.

To date, a hematologist also successfully uses the following methods for diagnosing anemia:

• CT scan;
• Ultrasound diagnostics;
• Nuclear magnetic resonance.

All these modern research methods allow the hematologist to identify the structure and size of organs, tumor formations, and various disorders of the skeletal system.

Among doctors of various specialties there is a specialty of a hematologist. Children are referred to a hematologist if there is a suspicion of diseases of the blood system.

WHAT IS THE BLOOD SYSTEM AND WHO IS A HEMATOLOGIST

There is probably no person who would not see what blood looks like. It is a dark red liquid that immediately appears when you cut or more seriously hurt. First, the blood is released in drops or flows out in a stream, and then it becomes thick, dense, and the bleeding stops. We say in such cases - the blood clotted.

But blood is not just red water. It has amazing properties. And one of them is the ability to stop bleeding with the participation of special proteins of the blood coagulation system.

Another feature of the blood, unlike all other organs and systems of the body, is that the blood is in constant motion, and this movement is strictly ordered. It's like a one-way street. In one direction, to the tissues, the blood runs through the arteries, supplying oxygen and necessary nutrients there, in the other, through the veins, carbon dioxide and other waste products of the cells are carried away from the tissues, which are then excreted from the body through the lungs, kidneys, intestines, and skin .

Thanks to the smallest branching of blood vessels - capillaries, blood washes every cell and is a link between all organs and tissues of the human body. No wonder this entire vascular system, and its length in an adult is more than 100 thousand kilometers, is called the "river of life."

The liquid part of blood is called plasma. Plasma is a real storehouse of nutrients. It contains proteins, fats, carbohydrates, vitamins, enzymes, hormones and, in minimal amounts, almost all known chemical elements of the Mendeleev system. They are called micronutrients. Some of them: iron, copper, nickel, cobalt - are directly involved in the process of hematopoiesis - the formation of blood cells.

And now I want to tell you about these amazing cells.

If we look at blood under a microscope, we will see that it contains many different cells. To do this, a thin smear must be prepared on glass from a drop of blood taken from a finger, painted with special paints, and a microscope will provide a large increase and allow them to be examined well.

blood under the microscope

red blood cells

Look, almost the entire visible field is dotted with many pink "plates".

These cells are called erythrocytes. The pink color is due to the hemoglobin contained in them. It is erythrocytes that provide tissue respiration. They transport oxygen and carbon dioxide with the help of a special protein called hemoglobin. And if there are few erythrocytes, and this happens with some blood diseases, oxygen starvation of tissues develops, from which the whole organism suffers.

And that's not all that red blood cells are capable of. It is known that different people have different blood types, positive or negative Rh factor. So, it is erythrocytes that carry information about the group and Rh affiliation of human blood.

You probably know your blood type, the blood type of your children and loved ones. There are only four of them, and they are designated as 0 (1), A (P), V (Sh) and AB (1U). It is important to know your Rh factor, especially for women. If an Rh-negative woman has a baby with a positive factor inherited from her father, their blood may be incompatible, and the baby may develop what is called hemolytic disease of the newborn. This happens when Rh-positive erythrocytes of the child enter the body of an Rh-negative mother through the placenta. The mother's immune system perceives them as foreign, and develops antibodies against them. This danger increases after repeated births or abortions, since with each pregnancy the number of such anti-Rhesus antibodies increases.
You also need to know your blood type and Rh factor because now many people are offered to become blood donors for their loved ones if they are seriously ill and need blood transfusions.

The discovery of blood groups and the Rh factor can be considered a revolution in hematology. It made it possible and safe to transfuse blood from person to person. It is only necessary that the blood of these people be compatible, and this is easily determined by the doctor immediately before the transfusion. It is thanks to this discovery that we have learned to save children with hemolytic disease of the newborn, using exchange transfusions.

Leukocytes

Here are the big cells. Inside them is a core, which consists of several segments, and fine grain is scattered around. These cells are called granulocytes, or neutrophils. And here are the smaller cells. They have a round nucleus, which occupies almost the entire cell. This is a lymphocyte. And cells with a bean-shaped nucleus are called monocytes. And all together: neutrophils, lymphocytes and monocytes - are defined in one word - blood leukocytes.
The role of leukocytes is difficult to overestimate. They protect the body from infections and other harmful effects, including providing anti-cancer immunity. At the same time, their functions are strictly delimited. For example, some types of lymphocytes, they are called T-lymphocytes, provide recognition of foreign cells and even remember what different microbes look like, others - B-lymphocytes, produce antibodies against them. And neutrophils and macrophages (macrophages are the same monocytes, but they work directly in the tissues) “devour” them. And in this struggle, not only microbes die, but the defending cells themselves.

Platelets

But in the blood smear there were still unnamed clusters of small dots. These are platelets. They are the first to enter the process of stopping bleeding.

Erythrocytes, leukocytes and platelets, or formed elements, are suspended in the liquid part of the blood - plasma and together with it constitute an important component of the blood system - peripheral blood.

Bone marrow. But the main organ of the blood system is the bone marrow, in which blood cells are born and mature. It is located deep in the bones.

Before entering the peripheral blood, cells undergo a complex process of development. First, they divide, resulting in the formation of two identical cells. And from these two cells then four are formed, from four - eight, etc. Then a long process of maturation takes place, and only after that the cells leave the bone marrow. At first, blood cells in the bone marrow are similar to each other, and only then, having gone all the way of development, having received “education”, do they become the erythrocytes, leukocytes and platelets already known to us.

Bone marrow

How does the process of cell division take place? At the head of this entire system is the ancestral stem cell, which, under the influence of special growth factors, can differentiate in various directions. One of its germ produces red blood cells, the other - neutrophils, the third - platelets. Lymphocytes and monocytes pass their way of development.

cell division

The functioning of the bone marrow as a hematopoietic organ begins very early, from the end of the third month of intrauterine life of a child, and before that, blood cells are formed in the liver, spleen and lymph nodes. These organs are then called so - the organs of facultative hematopoiesis, that is, not mandatory, but potentially possible. This is important to know, because under various pathological conditions, children easily return to this embryonic type of hematopoiesis, which explains the increase in these organs in many diseases, especially oncological ones.

In a healthy person, the bone marrow produces so many cells that it is enough not only to cover momentary needs. So, it contains 10 times more neutrophils than in the bloodstream, and young erythrocytes - a three-day supply. Therefore, in various pathological situations, the bone marrow can instantly respond with an increased flow of cells into the blood.

As you can see, hematopoiesis is a dynamic system that quickly responds to any impact that the body is exposed to. This often leads to diseases of the blood system itself.

Blood cells live for a relatively short time and die after doing their job. They are replaced by new cells from the bone marrow, ready to immediately begin to perform their duties. This process happens all the time. Red blood cells live the longest in the blood - 120 days, platelets - 10 days, and neutrophils - only 10 hours.

Spleen

In the body there is also a special organ in which old, spent cells are destroyed. This organ is called the spleen.

But the spleen has the ability to capture and destroy not only aged cells. In a number of diseases, it intensively captures and destroys blood cells that have been changed during the course of the disease or loaded with antibodies.

Thus, the blood system is the interaction of its three main components: bone marrow, peripheral blood and spleen.

If this well-established system is violated, diseases develop that are classified as diseases of the blood system. They can occur with damage to the bone marrow or directly to peripheral blood cells.

The science that deals with diseases of the blood is called hematology, and the doctor who treats patients with diseases of the blood system is called a hematologist, from the Greek word haima - blood.

WHAT COMPLAINTS DO WE APPLY TO THE HEMATOLOGIST

With blood diseases, general malaise, weakness, fatigue, loss of appetite are often noted. And often these complaints can be the first signs of very serious diseases that are associated with a violation of the main function of the bone marrow - hematopoiesis. Therefore, changes in the condition and behavior of the child must be a reason to see a doctor.

The subject of particular concern of parents is usually the pallor of the child's skin, sometimes with an icteric tint, the appearance of bruises, nose and other bleeding.
With blood diseases, children may also complain of pain in the bones, joints, and spine. Sometimes headaches, pains in a stomach disturb.

Often they turn to a hematologist about enlarged lymph nodes. Lymph nodes perform important protective functions in the body. They stand in the way of the possible spread of the disease and often cope with it on their own, through local inflammation. This is manifested in the increase and soreness of nearby lymph nodes.

Especially rapidly local inflammatory reaction when meeting with an infection is manifested in children of preschool age. In children under two years of age, this barrier function of the lymph nodes is not sufficiently developed. Infectious pathogens freely pass through such a node into the blood, the infection "disperses" throughout the body, and the disease often takes on a generalized (common) character.

In older children and adults, suppression of infection in the lymph nodes often goes unnoticed, asymptomatic.

Usually, regional (closest to the site of infection) lymph nodes are enlarged. For example, an increase in the submandibular glands during infections in the mouth and throat (carious teeth, stomatitis, tonsillitis). With cat scratch disease, the lymph node closest to the scratch site is enlarged. For some childhood infections, such as measles, rubella, infectious mononucleosis and other viral infections, an increase in the posterior cervical nodes is characteristic.

And for a hematologist and oncologist, it is important that in the lymph nodes - as organs of facultative hematopoiesis - there are favorable conditions for the development of tumor diseases such as leukemia, lymphogranulomatosis and other types of malignant lymphomas.
Therefore, an increase in lymph nodes, especially in atypical places that are not associated with specific foci of inflammation, requires the exclusion of the oncological nature of the disease.
Of particular note is the simultaneous enlargement of the lymph nodes, liver and spleen, which is typical, for example, for acute leukemia. Sometimes the enlarged organs reach such a large size that the mother can find them when dressing or bathing the child.

And if the central nervous system is involved in the process, then there is a headache, vomiting, signs of irritation of the meninges - meningitis. This also happens with acute leukemia.

WHAT RESEARCH IS A HEMATOLOGIST PERFORMING

If there is a suspicion of a blood disease, the doctor refers the child for a consultation with a hematologist or hospitalizes him in a special hematology clinic. After examining the patient, the hematologist conducts special hematological studies that provide very important information about various pathological conditions.

Diagnostic value of a blood test

Of course, you or your children have ever had a blood test and you were looking forward to the answer. In blood tests, indicators are presented that reflect the final result of the work of all hematopoietic germs in the bone marrow. We evaluate these results by the content of erythrocytes, leukocytes and platelets in the blood.

Indicators of red blood are erythrocytes and the protein hemoglobin contained in them. Healthy people should have at least 4 million erythrocytes, and at least 120 hemoglobin units. The content of hemoglobin in one erythrocyte determines the color index. It is low (hypochromic), normal and high (hyperchromic). With a decrease in red blood levels, anemia develops, which can be, respectively, normo-, hypo- and hyperchromic.
The normal content of leukocytes is from 4 to 9 thousand. In various pathological conditions, the number of leukocytes rises or falls, and then we say that the patient has leukocytosis, or leukopenia.

A blood smear is used to study the leukocyte formula, that is, the percentage of neutrophils, lymphocytes and monocytes. The leukocyte formula in children, unlike adults, has age-related features. For example, in a child of the first year of life, the percentage of cells is the opposite of the adult formula. Further, these indicators change, and only by the age of 12-14 do they approach the values ​​of adults, that is, neutrophils make up 60-70%, lymphocytes - 20-30% and monocytes - 5-10%.

In the blood formula there are still single cells, which are called eosinophils and basophils. They are involved in allergic reactions of the body.

The number of platelets does not change with age and should be at least 200,000.
Various changes in the blood have corresponding clinical manifestations.
With pallor of the skin, the doctor pays special attention to the decrease in the level of hemoglobin, erythrocytes and the nature of the color index.

In patients with severe infectious diseases, the number of leukocytes increases, and cells appear in the blood formula that have not completely passed the maturation process. Such changes in the blood occur in purulent-septic diseases and are called leukemoid reaction. With viral infections, on the contrary, the number of leukocytes and neutrophils decreases, and with leukemia, young “blast” cells appear in the blood smear, which are not found in blood tests in healthy people.

With a decrease in the level of platelets in the blood, bruises, petechiae (pinpoint hemorrhages), and bleeding appear. Sometimes bleeding occurs due to a decrease in the level of proteins in the blood coagulation system, as happens with hemophilia. Then they conduct a special blood test, which is called a coagulogram.

In what cases is it necessary to do a bone marrow puncture

If blood cancer is suspected, a bone marrow examination is required. To do this, a bone marrow is punctured with a special thin needle, piercing the bone in the region of the sternum or ilium. The resulting drop of bone marrow is examined in many ways, which makes it possible to make an accurate diagnosis and prescribe appropriate treatment.

First, the doctor examines the bone marrow under a microscope, and does this in exactly the same way as when examining a peripheral blood smear. However, unlike blood, where only mature cellular elements are present, all types of cells are present in the bone marrow - both very young, and those that mature, and mature. At the same time, cells that develop towards erythrocytes, leukocytes, and platelets are clearly distinguishable.

If the cellular composition of the bone marrow is normal, no additional studies are required. But if there are many young blast cells in the bone marrow, as is the case with leukemia, or the bone marrow is empty, as happens with hematopoiesis suppression, then special, additional studies are required.

Sometimes a small piece of bone is taken for analysis and, in specially prepared preparations, the structure and ratio of individual elements are studied directly in the bone tissue.
Today, methods of ultrasound diagnostics (ultrasound), computed tomography (CT), nuclear magnetic resonance (NMR) are also successfully used in the diagnosis of blood diseases. These modern studies make it possible to determine the size and structure of organs, various bone disorders, and reveal tumor formations of various localization.

WHAT DISEASES HEMATOLOGIST TREATS

anemia

iron deficiency anemia

The most common diseases of the blood system are anemia. Anemia is when the levels of red blood - hemoglobin and red blood cells - decrease. The concept of anemia includes diseases of a different nature, but most often they are associated with a lack of iron and therefore are called iron deficiency anemia.

Iron metabolism plays an important role in the construction of hemoglobin in maturing bone marrow erythrocytes. Iron is found in muscles (protein myoglobin) and is part of cellular respiratory enzymes. With a lack of iron in the body, many metabolic processes are disrupted.

Most often, iron deficiency anemia develops in children in the first two years of life. There are many reasons for this. Some depend on the conditions of intrauterine development, others on the characteristics of the development of children in the first year of life. So, a child may receive less iron even before birth: with severe toxicosis of pregnancy, with chronic diseases in the mother, especially if the mother herself suffers from iron deficiency anemia or is on a vegetarian diet. Children from twins, triplets and premature babies will also receive less iron per kilogram of weight, since iron enters the child in the last three months of pregnancy.
After birth, especially in the first year of life, the child grows rapidly. In a year, its weight triples, and blood volume - 2.5 times. Accordingly, the need for iron also increases sharply. And this is where the biggest difficulties arise.

Iron enters the body only from the outside - with food. Different foods contain different amounts of iron, and, unfortunately, the least of it is in milk. And if you remember that milk is the main food in the first year of life, it becomes clear why children of this particular age group are so often ill with iron deficiency anemia.

Fortunately, at this age, children are constantly with their parents and are regularly observed by a doctor in a children's clinic. Therefore, changes in the behavior, condition of the child, the appearance of pallor of the skin in most cases are detected in a timely manner and are successfully treated with iron preparations. At the same time, it is very important to establish a normal diet, timely introduce complementary foods, juices, mixtures enriched with vitamins. Properly replenished iron deficiency leads to the recovery of the child from anemia.
There is another group of children most susceptible to iron deficiency anemia - these are girls of puberty (puberty). At this time, there is also a rapid restructuring of the body and the need for iron increases sharply. These patients are usually diagnosed late. The disease accumulates for a long time and manages to develop the whole complex of symptoms characteristic of chronic sideropenia (the so-called iron deficiency). This is primarily fatigue, drowsiness, a sharp deterioration and perversion of appetite. Patients cannot stand the taste and smell of meat, fish and chew chalk and cereals with pleasure. Their skin is dry, hair and nails are dull and brittle. There are great changes in the mucous membranes of the oral cavity and pharynx, up to a violation of the act of swallowing.

In addition, at this age, menstruation begins, and in girls with any platelet disorders, they can take on the character of prolonged, heavy bleeding. In this situation, due to the loss of iron, iron deficiency anemia also develops.

Iron deficiency anemia also occurs with prolonged bleeding in small portions that are not visible to the "naked" eye. Such blood loss most often occurs from the mucosa of the gastrointestinal tract in various diseases, such as hiatal hernia, polyps, vascular tumors (hemangiomas), duodenal ulcer, etc.

A necessary condition for the recovery of patients in whom iron deficiency has developed as a result of chronic blood loss is the treatment of the underlying disease that caused the bleeding, and often surgically. Only after these activities is it possible to restore iron levels and recover from anemia.

Hemolytic anemia

The second most common group of anemias are the so-called hemolytic anemias. In these diseases, the bone marrow produces a sufficient number of red blood cells, but for various reasons they have a shortened lifespan and are rapidly destroyed.

Almost all hemolytic anemias are congenital, hereditary. However, heredity is different. Each trait in the body is controlled by two genes: one of them is the main, dominant, the other is secondary, recessive. A disease is considered dominant in which one gene is sick, but it is the main one and determines the disease, and the other is recessive, secondary - healthy. A disease is considered recessive if it is controlled by two recessive genes, and both of them are “sick” and carry the same pathological information. Diseases with recessive inheritance are more severe and have a serious prognosis.
Among hereditary hemolytic anemias, the most common is microspherocytic hemolytic anemia of Minkowski-Choffard. It is inherited according to the dominant type, and the genetic defect is located in the erythrocyte membrane.

Much less common are the so-called espherocytic hemolytic anemias, which are inherited in a recessive manner and are severe.

In this case, the cause of accelerated cell destruction is a congenital deficiency of one of the many enzymes that are contained in red blood cells.

As a result of the described disorders, erythrocytes in hemolytic anemia, as we have said above, have a shortened life span. With Minkowski-Choffard anemia, they are destroyed in the spleen, that is, in the organ where old, spent cells are destroyed under normal conditions. In non-spherocytic hemolytic anemias, hemolysis (cell destruction) occurs wherever there are macrophages capable of trapping altered red blood cells, such as in the liver, bone marrow, and other organs.

The main clinical signs for all types of hemolytic anemias are pallor of the skin, jaundice and an enlarged spleen. Such patients are constantly moderately pale and yellow, but periodically their condition deteriorates sharply, the temperature rises, the pallor and icterus of the skin increases. These are signs of an exacerbation of the disease, the so-called hemolytic crises. During this period, patients need special therapeutic measures, and often blood transfusions.

There is also a surgical method for the treatment of Minkowski-Choffard anemia. This is the removal of the spleen - splenectomy, that is, the removal of the organ responsible for the accelerated destruction of red blood cells.

Even if Minkowski-Choffard anemia is mild and crises are rare, over time such a severe complication as cholelithiasis develops. Removal of the spleen leads to recovery in all patients. Blood tests are normalized, jaundice disappears, the formation of stones in the gallbladder stops. However, the genetic defect remains, which is inherited. And even operated parents have a high probability of giving birth to a child with hemolytic anemia. But they already know about the miraculous effect of splenectomy.

This cannot be said about non-spherocytic hemolytic anemias. Fortunately, they are rare. Since the destruction of red blood cells occurs in many organs, the removal of the spleen has a partial effect or no effect at all.

We have become acquainted with such anemias, the origin of which is not directly related to impaired bone marrow function.

In the first case, anemia is associated with insufficient intake or loss of iron during bleeding, in the second case, anemia is caused by genetic disorders in the erythrocyte itself, as a result of which they have a shortened life expectancy and are intensively destroyed in the spleen and other organs.

Hypoplastic anemia

But the next type of anemia - hypoplastic, is directly related to the primary lesion of the bone marrow and impaired hematopoiesis. The name of the disease does not accurately reflect its essence, since we are talking not only about anemia, but also about the defeat of all hematopoietic germs, including those that produce leukocytes and platelets.

These children have low levels of white blood cells, red blood cells and platelets in blood tests, and the bone marrow contains large amounts of adipose tissue instead of normal hematopoietic tissue.

Hypoplastic anemias are congenital and acquired.

Fanconi anemia is a typical representative of the congenital form of the disease. Its peculiarity lies in the fact that hematological disorders are combined with other congenital malformations, most often from the bones. This may be the presence of additional fingers or the absence of one of them, growth retardation, small head sizes, incorrect dentition, etc. But the hematological component of this symptom complex appears later, at the age of 5-6 years, and then it is she who determines severity and prognosis of the disease.
In addition to the three-line lesion, as is the case with Fanconi anemia, there are partial forms when congenital disorders concern one of the three hematopoietic sprouts responsible for the production of red blood cells, white blood cells or platelets. These diseases appear already in the neonatal period and are very difficult.

Aplastic anemia

Acquired aplastic anemias constitute a special group. In each case, it is very difficult to establish the cause of the disease. It is believed that the disease is directly related to damage to the ancestral stem cell in the bone marrow - the same cell from which hematopoiesis develops in different directions. These can be toxic, infectious or immune effects.

The disease begins acutely, the condition worsens, pronounced pallor of the skin, bruises, bleeding of various localization appear. Sometimes the temperature rises.
Acquired aplastic anemia is severe. The disease progresses rapidly and without proper treatment can have an unfavorable outcome.

Treatment of aplastic anemia

Treatment of all types of aplastic anemia is a difficult task. It is often necessary to transfuse blood and its components - erythrocyte mass, thrombus suspension. They carry out complex measures aimed at restoring the function of hematopoiesis, with an impact directly on the stem cell.

Who is indicated and how is a bone marrow transplant performed?

In the absence of the effect of such therapy, all children with various types of hypoplastic anemia are indicated for bone marrow transplantation. This procedure is now widely used all over the world for various diseases - hypoplastic anemia, leukemia, various types of immunity deficiency, thalassemia, etc. However, it is not indicated for all children with this pathology, but only in those cases where drug therapy has been ineffective .

For bone marrow transplantation, a donor is needed, which must be compatible with the patient in many ways. For the health of the donor, this procedure is safe. Compatible donors are usually found among siblings, but in our small families with one or two children, it is difficult to find a donor. Parents, unfortunately, are rarely compatible with their children. Therefore, a new direction is being developed for the use of unrelated compatible donors. To search for such donors, there is a special data bank - the International Registry.

The bone marrow transplant procedure itself is not complicated. Bone marrow is taken from the donor under anesthesia from several injections in the iliac crest. It is passed through special filters and administered to the patient intravenously. But in order to transplant a donor's bone marrow, it is necessary to carry out special preparations that devastate the patient's own bone marrow. This is the only way to count on the engraftment of the transplant. In this situation, severe complications are possible that can nullify the entire procedure. For this, there are special methods for the prevention of complications and their treatment.

Today it is safe to say that the bone marrow transplant procedure has saved the lives of many patients.

What unites such different diseases

What unites these such different diseases and why is there the word "anemia" in all the names? And the fact that the main symptom here is the pallor of the skin and a decrease in hemoglobin and red blood cells in the blood test. This is what is defined by the term anemia. But the shades of this pallor and the anemia themselves are different.

For example, with iron deficiency, the shade of pallor is marbled, “blue-white”, with hemolytic anemia it is lemon yellow, and with aplastic anemia, a gray color of the skin is noted.
Therefore, when examining a patient, the doctor must pay attention to these shades. And this immediately directs the diagnostic thought in the right direction, and the conducted hematological examination allows clarifying the diagnosis and prescribing the correct treatment.
It must be remembered that some types of anemia are more common at a certain age. For example, iron deficiency anemia - in children of the first two years of life and in girls of puberty. And if iron deficiency anemia is determined in children of other age groups, then this is most likely associated with hidden bleeding and is defined as chronic hemorrhagic anemia.

The first signs of congenital hypoplastic Fanconi anemia appear at the age of 5-6 years, partial - immediately at birth, and acquired forms can develop at any age. Hereditary hemolytic anemia is usually diagnosed at preschool age, and the earlier, the more severe the disease is and the more parents are informed about this disease, that is, if there are already such patients in the family.

It should be noted that with anemia, the decrease in red blood counts can be moderate and very pronounced. Anemia can develop gradually and very quickly. Accordingly, the complaints of patients, their general condition will be violated to varying degrees.

With moderate anemia, children may not complain for a long time, and only very attentive parents will notice changes in the behavior and condition of the child. With severe anemia and, most importantly, with its rapid development, the child's condition worsens. He becomes very pale, lethargic, passive, palpitations are felt, shortness of breath appears. This happens with acute bleeding and hemolytic crises. Iron deficiency anemia, as a rule, develops gradually, and the clinical manifestations of the disease will be the more pronounced, the later the examination and diagnosis is made.

Blood diseases associated with increased bleeding

Another group of diseases is the so-called hemorrhagic diathesis. This also includes diseases of a different nature, but they are united by one main clinical symptom - increased bleeding.

How and why does bleeding stop?

Before talking about individual diseases of this group, two important questions need to be answered: why is the blood in intact vessels in a liquid state and does not clot, and how does bleeding stop when a vessel is injured, that is, how is hemostasis carried out?

This is due to the fact that the factors involved in the process of blood coagulation are in an inactive state in the blood plasma, and, in addition, there are corresponding anticoagulant mechanisms.

The system starts working only if there is an injury to the vascular wall. Then all the necessary mechanisms are included in the process of stopping bleeding - platelets, the vascular wall itself (its ability to contract is important) and the blood coagulation system. Platelets are the first to react to injury, as they directly line the vessel from the inside. Through complex transformations, they form a hemostatic plug - a “patch” and, together with vasospasm, provide primary hemostasis.

Upon contact with a damaged vascular wall, special proteins are also activated - coagulation factors that are in the plasma. The process of blood coagulation starts, and the primary platelet thrombus is replaced by a dense fibrin clot, which further acts as a hemostatic plug until the injured part of the vessel heals.

Thrombocytopathies

The most common diseases in the group of hemorrhagic diathesis are the so-called thrombocytopathies. They are based on the qualitative inferiority of platelets with their normal number.

Since platelets have different properties, there are many different types of thrombocytopathy. All of them are hereditary diseases.

Typically, such patients complain of nosebleeds and a tendency to bruising. Girls may have long and heavy periods.

Most thrombocytopathy is mild, but there are rare forms that are severe and require special treatment.

The blood test in such people is normal, and in order to establish what kind of defect there is, it is necessary to conduct complex studies of the dynamic properties of platelets. Often people with this pathology do not consider themselves sick. They stop frequent, mild nosebleeds on their own, bruises easily occur, but quickly pass, and they consider prolonged uterine bleeding to be their feature. Moreover, there are no special methods for the treatment of thrombocytopathies.

Thrombocytopenic purpura

If increased bleeding is associated with a decrease in the number of platelets (thrombocytopenia), then they speak of thrombocytopenic purpura (TPP). Thrombocytopenic purpura can be an independent disease, or it can be a symptom of other serious illnesses. We have already talked about one of them - aplastic anemia.

Thrombocytopenia occurs when the properties of one's own platelets change as a result of an infection, such as a respiratory viral infection, or drugs. Under these conditions, the cells responsible for immunological surveillance perceive them as foreign and begin to produce antibodies against them. And already these altered platelets, blocked by antibodies, are captured by special cells of the spleen and destroyed there. If an infection is usually responsible for a change in the properties of platelets, then repeated infectious diseases, trauma, insolation, hypothermia, preventive vaccinations, etc. can be a resolving factor immediately preceding the development of thrombocytopenia.

The clinical manifestations of the disease are similar to those described for patients with thrombocytopathies. But, if in the first case they continue constantly, almost all their lives, then in patients with TPP they occur suddenly and are more pronounced.

The main elements of the rash are bruises and petechiae.

Bruises are blue spots located everywhere, but mainly on the shins. Bruises arise from minor injuries, have different shapes and different sizes. Depending on the age of occurrence, they have a different color - from blue to yellow-brown.

Petechiae is a small pitted rash, which is also more often located on the legs. The number of such hemorrhages is from single to very abundant. In severe forms, hemorrhages in the mucous membranes and bleeding are noted. Bleeding from the gums and nasal mucosa is especially characteristic. Sometimes bleeding is so severe that it is necessary to pack the nasal passages and transfuse freshly prepared platelet mass. TPP is especially dangerous for girls at puberty. They may experience profuse uterine bleeding.

Newly diagnosed TPP proceeds as an acute disease that can end in recovery or become the onset of a severe, chronic illness.

Treatment is aimed at the destruction of aggressive antiplatelet antibodies and the elimination of bleeding. To do this, prescribe special drugs, and with heavy bleeding, you even have to transfuse blood products. For most children, this is enough. The number of platelets is restored, hemorrhages and bleeding stop.

However, this does not mean recovery for all patients. If the disease has become chronic, then episodes of bleeding are repeated, and then the issue of radical treatment is decided - removal of the spleen. Just as with hemolytic anemia, the organ where the cells are destroyed is removed. Removal of the spleen (splenectomy) and TPP gives good results and is the method of choice for severe chronic forms.

If at the beginning of the disease it is difficult to talk about any preventive measures, then with an existing disease, it is possible and necessary to carry out the prevention of exacerbations. To do this, it is necessary to cure all foci of chronic infection - carious teeth, inflammation of the adenoids, chronic tonsillitis and others. Children for this period are exempted from physical education. It is not recommended to sunbathe, take drugs that violate the dynamic properties of platelets - first of all, aspirin, chimes, indomethacin, etc. A medical withdrawal from preventive vaccinations is given. Within five years after TPP, children should be observed by a hematologist.

Hemorrhagic vasculitis

Another disease that should be considered and which is also quite common in children is the so-called hemorrhagic vasculitis. With this disease, antibodies are also produced, but they are not directed against blood cells, but against cells lining the vascular wall from the inside. These cells are called endothelium.
Antibodies destroy the endothelium and make the vascular wall easily permeable in both directions - from tissues to blood and from blood to tissues. Substances enter the blood from the tissues, which further destroy the vascular wall, and blood flows from the vessels into the tissues, which causes a rash on the skin. But this rash differs from bruises both in character and location. It looks like pink rounded spots (papules) on the legs, arms, buttocks. But on the face, the trunk of the rash does not happen.

Hemorrhagic vasculitis is also characterized by pain and swelling of the small joints of the arms and legs, pain in the abdomen. Sometimes there may be blood in the urine. As with TPP, some kind of infection precedes the disease, and then, under the action of a resolving factor, hemorrhagic vasculitis develops. The disease can proceed easily and severely, has a tendency to early exacerbations.
Treatment of hemorrhagic vasculitis has its own characteristics. Since we are talking about damage to blood vessels, it is necessary to take measures aimed at preventing intravascular coagulation. To do this, prescribe a special drug heparin and drugs that prevent platelets from sticking together - the so-called antiplatelet agents.
It is also necessary to carry out treatment (sanation) of all foci of chronic infection. Treatment is usually effective. Children get better, but the duration of treatment, depending on the severity of the course of the disease, varies from one to several months.

Hemophilia

Hemophilia occupies a special place in the group of hemorrhagic diathesis. The disease is based on a congenital, hereditary violation of blood coagulation due to a lack of VIII or IX factors. Accordingly, hemophilia is A and B. The peculiarity of inheritance in hemophilia is that the disease is sex-linked. The disease is transmitted from grandfather to grandson through a daughter, who is called a "conductor". Such a woman has a high probability of giving birth to hemophilic sons, and in such families there are almost always also men suffering from hemophilia.

Unlike TPP, hemophilia is characterized by prolonged, difficult to stop bleeding, hemorrhages in the joints, subcutaneous and large intramuscular hemorrhages - hematomas, which then resolve for a long time.

The first signs of the disease may appear already in the first year of life, when teeth erupt or when the child begins to walk, often bruises and falls. However, already in the neonatal period, there may be prolonged bleeding from the umbilical wound or extensive subperiosteal hemorrhage on the head, the so-called cephalohematoma.

Repeated hemorrhages in the same joint lead to its deformation, and pain in the joint limits movement. This causes muscle atrophy, causing children to stop walking. The leg is fixed in a bent position "hook". The disease, as it were, "fetters" the child. This happens if it is not possible to provide patients with timely and correct treatment.

And the treatment of hemophilia is a difficult problem, since this requires a powerful blood transfusion station, where special preparations containing concentrates of VIII and IX factors are prepared. In addition, with patients it is necessary to constantly engage in physiotherapy exercises, swimming in the pool is recommended. Children are exempt from physical education at school and heavy physical exertion. Timely sanitation of the oral cavity is necessary, since heavy bleeding occurs during the extraction of teeth. If all the necessary therapeutic and preventive measures are taken, patients can lead a fairly active lifestyle.

Acute leukemia in children

Now let's talk about acute leukemia. This oncological disease by its nature is classified as oncohematological, since we are talking about the defeat of the main organ of the blood system - the bone marrow.

The basis of the disease is a violation (mutation) of one of the parent stem cells of the bone marrow, which gives rise to a new diseased generation (clone) of cells. These cells get out of control of regulatory mechanisms, begin to multiply uncontrollably, losing the ability to mature. As a result, a huge number of such diseased cells - blasts - accumulate in the bone marrow.

As they leave the bone marrow, blast cells are carried by the bloodstream throughout the body and enter various organs and tissues. Particularly favorable conditions are found in the liver, spleen and M0zg in leukemia of the lymph nodes. It was in these organs that the function of hematopoiesis was carried out in the early stages of intrauterine development. Here, these diseased cells multiply freely and cause an increase in organs.

And another dramatic situation continues in the bone marrow. Having accumulated in large numbers, these immature cells displace normal hematopoietic tissue, as a result of which only a small number of mature, functionally complete cells - erythrocytes, leukocytes, and platelets - enter the peripheral blood. With their lack, as we have already discussed above, pallor of the skin is noted, bruises appear and a tendency to infectious diseases. And the appearance in the blood test of young, immature cells - blasts, unable to perform the duties of healthy, mature blood cells, is the main sign of leukemia.

Thus, doctors today have a fairly good idea of ​​how this disease develops, they can explain certain symptoms, but so far no one knows the exact cause of leukemia.

Scientists suggest that so-called proto-oncogenes preexist in the body, which are in an inactive state and have no pathological significance for the body. But under the influence of some, often unknown to us, external influences, they are activated, penetrate into a healthy cell and cause its change (mutation). And she is already creating a clone of her own kind - diseased cells. This proto-oncogene is similar to a viral DNA particle, so sometimes this theory of the occurrence of leukemia is called viral. However, it has nothing to do with the spread of common viral diseases, such as influenza, measles, rubella, etc. Leukemia is a non-contagious disease, and it cannot be contracted through contact with a sick person.

Leukemia is not a hereditary disease. Sick children, as a rule, are born in healthy families in which cancer patients are found no more often than among other population groups. Recurrent cases of leukemia in children in the same family are extremely rare, although they do occur in identical twins. A predisposition to leukemia is noted in children with Down's disease, as well as in other diseases based on genetic disorders.

Parents who have been ill with leukemia in childhood have healthy children. However, there are cases of congenital leukemia, when the disease manifests itself in a child already in the first three months of life. At the same time, the parents of such children are practically healthy people. This happens if one of the parents has a mutation directly in the germ cells, without affecting the entire body. Then pathological genetic information is transferred to the child, and children can be born with any congenital disorders, including leukemia.

This is what the bone marrow looks like in leukemia

A few words about the mutations themselves. In the body, mutations, that is, changes in cells, occur constantly, at a rate of approximately one cell per hour. But in a healthy body, a powerful immunological defense works, which perceives these cells as foreign and destroys them.
Thus, the development of leukemia, like other oncological diseases, is possible only with an unfavorable combination of mutagenic factors and a weakening of the body's defenses, including anti-cancer immunity.

We know even less about the mutagenic factors themselves that bring these proto-oncogenes out of their dormant state. The role of ionizing radiation is described, as evidenced by the consequences of the explosion of atomic bombs in Japan. In the cities of Hiroshima and Nagasaki, leukemia occurs several times more often than in other cities.

However, for today's leukemia, for example, in Russia, this does not matter. There is no increase in the frequency of leukemia and other oncological diseases in children after the Chernobyl accident. Rather, we are talking about the damaging effect of small doses of radiation. The role of some chemicals, occupational hazards in parents and other factors are described. However, in each case, it is rarely possible to establish the cause of the disease.

It should also dwell on the differences between childhood and adult leukemia. In children, mainly acute forms originating from immature lymphocytes are noted. Approximately 80% of childhood leukemias are acute lymphoblastic leukemias (ALL), and only 15-20% are acute myeloid leukemias (AML). Chronic forms of leukemia in children are extremely rare. In adults, the picture is reversed. They are more likely to have chronic leukemia, and of the acute ones, more often AML and less often ALL. These differences are associated with the anatomical and physiological characteristics of the child's body.

Leukemia affects both very young children and very old people. Peak childhood leukemia occurs in preschool age. Less commonly, leukemia occurs in children under one year old and after 10 years.

The first signs and course of leukemia in children

The disease develops gradually. From the onset of the disease to the appearance of the first clinical signs of the disease, at least 1.5-2 months pass. During this time, the accumulation of pathological, "sick" cells occurs, and the quantity turns into quality - the disease makes itself felt.

But even in these 1.5-2 months there are already complaints that parents do not always pay attention to. This is primarily a change in the behavior of the child. He gets tired, refuses to eat, studies worse, loses interest in peers and games. Due to a decrease in the body's defenses, colds and other infectious diseases are possible already in the initial period of leukemia, which occur with an increase in temperature. Sometimes an increase in temperature can be directly related to the development of leukemia itself. If during this period you go to the doctor and do a blood test, then you can already note some changes that are still not enough to make a diagnosis, but which already make you think and continue monitoring the sick child.

Then there are more definite signs of the disease.

Some children complain of pain in the legs, in the spine. The pains are persistent and appear in one area or another. Such patients often stop walking and are treated for a long time by traumatologists and cardiologists for "trauma" or polyarthritis.

The appearance of increasing pallor of the skin, bruises, an increase in the size of the liver, spleen and lymph nodes makes the suspicion of leukemia more likely.

And in the blood test at this time there are already all the changes characteristic of leukemia: a decrease in the content of hemoglobin, erythrocytes, platelets, a sharply accelerated ESR. But the number of leukocytes can be low, high, and very high. The more blast cells got from the bone marrow into the blood, the higher the number of leukocytes. The appearance of blasts in a blood test, which never happens in a normal analysis, is an absolute sign of acute leukemia.

In this situation, a bone marrow puncture is required. This is necessary not only to confirm that the bone marrow is entirely represented by blast cells. It is important to study the structural features of these cells, whether they belong to a T- or B-cell line, to identify the presence of cytogenetic disorders. Additional information obtained in this way helps to diagnose various variants of leukemia, identify additional risk factors for an unfavorable course of the disease, and prescribe adequate treatment.

And only after that, a substantive conversation with parents about the diagnosis, treatment and prognosis of the disease is possible.

Modern methods of treatment of leukemia in children

Great progress has been made in the field of treatment of childhood leukemia over the past 10-15 years. If earlier the diagnosis sounded like a sentence, now most children recover and fully adapt to a full life. Today it is a disease that can and should be treated.

Since the beginning of the 1990s, new treatment programs have been used in the treatment of leukemia in children. They use several drugs with antitumor activity at the same time, and these drugs are prescribed in large doses, much higher than conventional therapeutic ones. The course of treatment is designed for a long period, which is a total of 2 years.
Treatment programs are developed taking into account the type of leukemia and the presence or absence of additional risk factors for a possible relapse (return) of the disease. That is why it is so important to carefully conduct a bone marrow examination and select an appropriate treatment plan (protocol) when making a diagnosis. Therapy is usually accompanied by severe infectious complications and increased bleeding. However, there are methods for the prevention and treatment of these complications, which allows most children to complete the intended treatment program.

In especially severe cases, when drug therapy does not guarantee success, the question of the need for bone marrow transplantation is raised. To do this, the relatives of the patient are examined and, if they are suitable, they are used as donors. For more details about the bone marrow transplantation procedure, we talked in the section on hypoplastic anemia.

In many ways, the results of leukemia treatment also depend on the parents, on how timely they went to the doctor and how selflessly they fought for the life of the child, helping the medical staff during the treatment.

OBSERVATION BY A HEMATOLOGIST

All children with an established hematological diagnosis are under the supervision of a hematologist. This is a dispensary group of patients.

Some continue the treatment started in the hospital, others are observed after the therapy is discontinued, and still others undergo the entire process of diagnosis, treatment and follow-up on an outpatient basis.

Children are usually invited for control once a week, unless the doctor individually prescribes otherwise. The child is examined by a doctor, the necessary tests are taken, and corrections are made in the treatment.

Some children are treated in the day hospital regime or, as it is also called, "day hospital". Here, the child receives all the necessary diagnostic and treatment procedures during the day, after which he goes home. Treatment in this mode can last quite a long time. In terms of its capabilities, such a day hospital is no different from a specialized hematology department. Here you can do ultrasound, X-ray, CT, NMR and other diagnostic procedures, perform the necessary puncture studies, transfuse blood, administer medications, consult with specialists of any profile.

World experience in managing patients with a variety of diseases has shown that this practice is optimal for both the child and the family, if the condition of the sick child allows.
Even for patients with leukemia, treatment programs are designed in such a way that they can spend most of their time at home in a familiar, family environment. And this not only has a positive effect on the mood of the child and the situation in the family, but is also an important factor in the prevention of nosocomial infections.

Many children with blood disorders are disabled in childhood. Disability is set for 5 years or immediately up to 16 years, depending on the disease. During all this time, the hematologist solves not only purely medical issues, but also a number of social problems that the families of sick children face: homeschooling, and the provision of additional days off, and admission to physical education, and preventive vaccinations , and referral to sanatorium treatment.

Career guidance issues are discussed with older children. For example, patients with hemophilia are not recommended to choose specialties associated with the risk of increased injury. At the same time, adolescents who had leukemia in early childhood are considered practically healthy people and can choose a specialty in accordance with their wishes.

Now the question is often discussed - up to what age should a pediatrician and, in particular, an oncologist, a hematologist observe their patients? Today, such children are under observation until the age of 15. But an increasing number of experts believe that these terms should be increased to 18 years, and such a law has already been adopted.

In some countries, patients with childhood-onset or adolescence-onset chronic illnesses are followed up by pediatricians until the age of 21.
One thing is undeniable: adolescents with oncological and onco-hematological pathologies should follow the treatment programs adopted in pediatric practice.

Today, pediatric hematology and especially pediatric onco-hematology are successfully developing. Recent years have been marked by a significant enrichment of new knowledge about blood diseases.

Methods for the immunological determination of variants of tumors and leukemia, cytogenetic and molecular biological studies, ultrasound, CT and NMR methods, new methods for diagnosing infectious complications, and others have been introduced into everyday practice.

Significant progress has been made in the treatment of patients with leukemia and other blood diseases. This became possible thanks to the establishment of close scientific and practical ties with foreign colleagues, the introduction of new modern methods of examination and treatment of patients.
Pediatric hematology as a separate section of modern hematology attracts special attention of researchers. Due to the age-related variability of the child's body and, in particular, the blood system, diseases in children proceed differently from adults and in some cases have a better prognosis. Some diseases that are common in adults do not occur in children at all, and vice versa.

On the other hand, it is in childhood that hereditary blood diseases and the consequences of the damaging effects of various factors during the intrauterine formation of the blood system or immediately after birth are often detected. And the quality of human life in the future depends on how pediatric hematologists cope with them.

Particular optimism is given by the immediate prospect of a complete cure for leukemia and other tumors in children, which we have already come close to today.

Book a Hematologist

Who is a hematologist?

The qualification of a hematologist can be obtained by a general practitioner who has received additional training in the field of hematology. This means that in order to obtain the specialty "hematologist" after graduating from a medical university, a doctor must complete an internship or residency in the specialty "therapy", after which he additionally attends a specialized course in hematology.

Hematologists work in two main areas. First, hematologists-clinicians carry out the prevention, diagnosis and treatment of various blood diseases. Hematologists of this profile work directly with patients, prescribe tests and treatment, control the course of therapy, select drug dosages, choose a treatment method, etc. Secondly, hematologists work in specialized laboratories where they perform complex analyzes of blood and bone marrow samples. So, hematologists working in laboratories study the state and cellular composition of the bone marrow, produce complex methods for staining blood and bone marrow preparations, do studies of the blood coagulation system, determine blood groups and the Rh factor in difficult cases (for example, when a person has an unusual group blood), as well as conduct any diverse and highly specialized tests to detect various blood diseases. Hematologists working in laboratories are primarily involved in diagnosing blood diseases, as they have the knowledge and skills to perform the necessary, sometimes very complex analyzes and interpret their results.

At first glance, it may seem that a hematologist working in a laboratory is the same laboratory assistant who does not perform different tests, but only those that allow you to identify and verify diseases of the blood system. However, this view is superficial and untrue. In reality, the laboratory doctor is not able to correctly interpret the results of specialized hematological tests, since he does not fully possess the necessary knowledge to perform specific tests, interpret their results, and distinguish between various blood and bone marrow cells that are at different stages of maturation.

Hematologists are often involved in joint work with doctors of other specialties, if there are also disorders of the blood system in any diseases that fall within their area of ​​responsibility. So, surgeons most often cooperate with hematologists in the treatment of vasculitis, DIC and secondary thrombosis in thrombocytopenia. Also, very often hematologists are attracted as consultants by traumatologists, faced with the need to treat hemarthrosis in hemophilia and von Willebrand disease, compression fractures of the spine in multiple myeloma. In these cases, surgeons and traumatologists can only perform "their" part of the treatment, for example, by performing an operation, removing blood from the joint, etc., but for further management of the patient, he needs the help of a hematologist who can prescribe adequate therapy for a long prevent the development of severe conditions requiring the intervention of a surgeon or traumatologist.

In addition, hematologists work very closely with oncologists, since the treatment of malignant diseases of the blood system (leukemia, hematosarcomas, etc.) requires the participation of both oncologists and hematologists. Quite often, oncologists involved in the treatment of malignant diseases of the blood system receive an additional qualification of a hematologist, and in this case they become hematologists-oncologists. A doctor of such qualification deals exclusively with the detection and treatment of malignant diseases of the blood system.

Hematology is divided into three main sections:

• General hematology. He studies the diagnosis and treatment of non-malignant blood diseases (anemia, hemophilia, pancytopenia, etc.).
• Oncohematology. He studies the diagnosis and treatment of malignant diseases of the blood system (leukemia, hematosarcoma).
• Theoretical hematology. He studies the problems of blood transfusion, the mechanisms of hematopoiesis and blood destruction. It is a purely scientific branch of hematology, which is not dealt with by practicing hematologists.

Pediatric hematologist

Hematologist-oncologist

To qualify as a hematologist-oncologist, a doctor must complete a residency or internship in oncology after graduating from a higher medical school, and then an additional specialization in hematology.

What does a hematologist treat?

1. Anemia of any origin.

3. Leukemia (acute and chronic lymphocytic leukemia, myeloid leukemia, myeloma, erythremia, etc.).

6. Blood clotting disorders:

• Increased bleeding (hemophilia, von Willebrand disease, Wiskott-Aldrich syndrome, Fanconi syndrome, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, DIC, Glanzmann thrombasthenia, Bernard-Soulier thrombodystrophy, Chediak-Higashi syndrome, hemorrhagic diathesis (for example, Rendu disease) Osler-Weber and Scheinlein-Genoch disease), Hageman, Fletcher defects, Quick's disease, Ovren's disease, Stuart-Prauer's disease, Waldenström's macroglobulinemia, deficiency or excess of coagulation factors in the blood, etc.);
• Increased blood clotting with the formation of thrombosis (viscous platelet syndrome, lupus syndrome, thrombocytosis, etc.).

• Non-Hodgkin's lymphomas;
• Hodgkin's lymphoma (lymphogranulomatosis).

Hematologist's appointment

General information

• Do not eat within 12 hours before consulting a doctor;
• Do not drink large amounts of liquid during the day before the doctor's appointment;
• Do not drink alcohol and do not smoke for 1 - 1.5 days before seeing a doctor;
• 3-4 days before the appointment with a hematologist, stop taking medications (if possible).

In addition to following these preparation rules, before taking it, it is recommended to remember at home in a calm atmosphere all the disturbing symptoms, the period of their appearance, the history of development (how the symptoms changed over time), as well as what medications were taken to eliminate them, what tests were given, etc. Be sure to indicate which medications the person is currently taking. It is recommended to write down all this information in a concise version on paper, and at the doctor’s appointment, simply read or tell, checking the accuracy of the indicated data according to one’s own records. There is no need to be embarrassed to read your doctor's notes, as this way of reporting complaints and troubling symptoms is concise, quick, and very accurate.

During the appointment, the hematologist, after listening to the history of the disease (existing complaints, the moment they appeared, etc.), will examine you. For examination, the doctor may ask you to open your mouth in order to examine the mucous membranes of the mouth and throat with the eye, and also look at the color of the whites of the eye and examine the condition of the skin of the body.

After examining and studying the history of the disease, the doctor will additionally prescribe any of the following tests:

• General blood analysis ;
• The number of platelets and their forms in the blood;
• Coagulogram;
• Mutations in the genes that provide the synthesis of proteins and blood cells (for example, polymorphism of the genes of the blood coagulation and fibrinolysis system);
• Bone marrow puncture with myelogram count;
• Staining of blood smears and bone marrow in various ways in order to identify existing disorders;
• The concentration of homocysteine ​​in the blood;
• Ferritin level;
• Iron-binding capacity of serum, etc.

• Ultrasound of the lymph nodes;
• Ultrasound of the abdominal organs;
• Biopsy of tissues of the lymph nodes with subsequent histological examination;
• X-ray of blood;
• Scintigraphy of the bones in which the bone marrow is located.

What tests are needed to see a hematologist?

• General blood analysis;
• The number of platelets in the blood;
• The number of reticulocytes in the blood;
• The concentration of ferritin and homocysteine ​​in the blood;
• Coagulogram (including D-dimers and RFMK);
• Polymorphism of the genes of the system of blood coagulation and fibrinolysis.

When should you see a hematologist?

• High body temperature, which lasts for a certain period of time against the background of the absence of infectious diseases, or causeless temperature fluctuations;
• Weight loss for no apparent reason;
• General weakness;
• Increased sweating;
• Pale skin and mucous membranes;
• Feeling of numbness or tingling in the fingertips;
• The appearance of bruises after minor bruises or is completely unreasonable;
• Nasal, gingival or uterine bleeding, observed repeatedly;
• Persistent redness of the skin of the face;
• Low level of hemoglobin in the blood;
• Enlarged lymph nodes of any localization;
• Any visible or palpable masses in the neck, armpits or groin.

• Paleness of the skin and mucous membranes, including with an icteric tint;
• Nose and gum bleeding, or bleeding of any other localization;
• Causeless bruising on the body;
• Pain in the spine, bones or joints;

Hematologist during pregnancy

However, in addition to this, gynecologists conducting pregnancy also refer to a hematologist women who have any abnormalities in blood clotting tests(coagulogram). The reason for referring such women to a hematologist is the need to find out the cause of deviations from the norm in blood coagulation. In such situations, hematologists perform the necessary additional tests, identify the cause of the violations and prescribe the appropriate treatment. It is impossible to ignore abnormalities in blood coagulation during pregnancy, since such violations may indicate the development of serious diseases (for example, thrombophilia, DIC, etc.) that can lead to pregnancy loss (miscarriage, premature birth or intrauterine fetal death).

In addition, gynecologists must refer pregnant women who have had or currently have any blood or vascular diseases (for example, hemorrhagic syndrome, vasculitis) for a consultation with a hematologist. In such cases, the pregnancy is carried out simultaneously by both the gynecologist and the hematologist. Moreover, each specialist prescribes the necessary examinations and treatment that corresponds to his profile and is necessary for the successful bearing of the fetus and the prevention of complications during childbirth (bleeding, thromboembolism, etc.).

Women who have lost more than two pregnancies in the past(miscarriage, miscarriage, failures in IVF protocols, etc.), before planning the next pregnancy, it is imperative to get a consultation with a hematologist and undergo an examination. An examination by a hematologist in such situations is necessary, since very often the cause of loss or miscarriage is the pathology of the blood system (for example, antiphospholipid syndrome, thrombophilia, thrombocytopathy, hemorrhagic syndrome, etc.). And a hematologist will be able to make a correct diagnosis and carry out treatment, as a result of which a woman will be able to become pregnant and successfully bear a healthy child.

Women who are just planning a pregnancy and do not have obvious signs of diseases of the blood system are advised to consult a hematologist if they have the following symptoms:

• Increased or decreased number of leukocytes, platelets or erythrocytes, changes in the leukocyte formula, increased or decreased ESR or hemoglobin concentration in at least two blood tests (it must be remembered that such changes must be recorded in two blood tests that were taken consecutively. For example, the first an abnormal test was taken in January and a second one in March (If there were normal tests between the two abnormal tests, it doesn't count and you don't need to see a haematologist).
• Enlarged liver and / or spleen (except in cases with existing hepatitis).
• Prolonged enlargement of the lymph nodes of any localization.
• Skin itching against the background of the absence of rashes and skin diseases.
• Bruising and bruising with minor injuries, frequent nosebleeds, profuse and prolonged bleeding with small cuts and abrasions.
• Elevated body temperature for a long period of time against the background of the absence of infectious diseases.
• Past vascular diseases (for example, acute cerebrovascular accidents, myocardial infarction, deep vein thrombosis, pulmonary embolism, thrombophlebitis, etc.).
• The presence of vascular diseases in blood relatives of the first line of kinship (mother, father, siblings, sisters).
• The need to take hormonal drugs.

Where does a hematologist take?

General information

In addition, hematologists work at blood transfusion stations, in specialized hematology centers, oncology dispensaries or oncology research institutes, as well as in hematology laboratories at large hospitals. But hematologists working on the basis of hospital departments or in laboratories do not see patients.

Hematologist in the hospital

Hematologist at the polyclinic

Hematologist at the maternity hospital

How to get an appointment with a hematologist?

Hematologist consultation free of charge

Paid hematologist

In a private clinic, a hematologist also sees a patient for a fee at any available free time. For your own convenience, it is also recommended to make an appointment with a doctor in advance, even in a private clinic.

Appointment with a hematologist

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There is a special branch of medicine that studies the structural features of blood and bone marrow, called hematology. This science also considers all diseases associated with the most important process in the human body - hematopoiesis. Accordingly, a hematologist, as a doctor, is engaged in therapy for diseases of the blood and blood-forming organs, as well as research activities in this area.

Competence of a hematologist: duties and specifics of activity

The competence of this specialist includes studying the structure and functions of the blood system, finding out the causes and mechanisms that cause diseases in this part in children and adults, as well as improving methods for their recognition, diagnosis and treatment. All processes related to blood are not complete without the advice of this doctor. This includes:

1. Accompanying medical history circulatory system.
2. Examination of possible pathologies, in particular, their nature - hereditary or acquired, ecological or oncological.
3. Introduction of drugs into the treatment process.
4. Prevention and post-rehabilitation period.
5. Collecting blood from the population. At the points of delivery of donor material, there is a mandatory presence of a hematologist who is directly involved in the process, monitoring the quality of incoming blood and the absence of dangerous diseases in donors based on the results of research tests.

Hematologists are in close contact with other specialist colleagues. First of all, these are gynecologists, oncologists and surgeons, and, of course, pediatricians. Each person at least once in his life donated blood for analysis, but he hardly heard of a special medical profession.

What will heal?

Scientists say that in our time, blood diseases account for 8% of all confirmed diagnoses of a modern person. Answering the question, the hematologist, what treats, should be listed:

• oncological indications - leukemia, lymphocytic leukemia, bone marrow diseases, sarcomas;
• multiple myeloma;
• myeloid leukemia; lymphomas;
• hemophilia, diseases of the liver and spleen, in particular hepatitis;
• macroglobulinemia Valdestrom;
• iron deficiency anemia - a decrease in red blood, hemoglobin and red blood cells due to a lack of iron. Most often they are observed in children of the first two years of life due to intensive growth, as well as in girls during puberty.
• hemolytic anemia, in which the bone marrow produces a normal number of red blood cells, but they break down too quickly and have a shortened lifespan. Almost all cases of such anemia are hereditary, congenital.
• aplastic anemia - diseases associated with the concomitant damage to the ancestral stem cell in the bone marrow, which is responsible for hematopoiesis
• autoimmune thrombocytopenia.

When to see a specialist, or symptoms of a hematologist

When certain symptoms are detected, consultation with a specialist is of particular importance. What is it? First of all:

• an increase in body temperature for no apparent reason, a feverish state;
• rapid loss of body weight with a normal daily routine and nutrition;
• increased work of the sebaceous glands and, as a result, increased sweating;
• pale skin, hyperemia of the skin, which are not associated with disruption of the internal organs or chronic diseases;
• persistent change in the level of erythrocytes, platelets, leukocytes, changes in the leukocyte formula;
• tingling and numbness of the fingers of the upper extremities;
• fragility, fragility of blood vessels, capillaries;
• the formation of hematomas in the absence of injuries and external damage;
• lack of appetite, feeling of constant weakness and fatigue;
• atypical hemoglobin level - a drop or vice versa its increase, which goes beyond the norm;
• skin itching after water procedures;
• bleeding of blood vessels, gums during dental procedures, slow healing of wounds and even scratches;
• chronic headaches, the sources of which have not been clarified;
• chronic menstrual disorders in women, prolonged bleeding, recurrent spontaneous miscarriages;
• frequent viral diseases, constant colds;
• formations on the neck, in the armpits, in the groin, a significant increase in the size of the lymph nodes;
• enlarged liver, spleens of any etiology;
• thrombosis, PE - pulmonary embolism;
• a history of myocardial infarction.

Without fail, a consultation of such a doctor as a hematologist is necessary in case of an already onset pregnancy, when planning a conception, as well as residents of areas with a high radioactive background, which is especially important in connection with man-made disasters. An examination by a medical specialist as a preventive measure is a necessary measure aimed at preventing unpleasant health surprises.

When does a child need counseling?

A pediatrician deals with specific symptoms in children in the following cases:

• pale skin, very often with an icteric tint;
• nose and other bleeding;
• weakness, drowsiness;
• irritability of the child, frequent inattention;
• loss of appetite and unmotivated rises in body temperature;
• enlarged lymph nodes;
• bruising for no apparent reason;
• complaints of pain in the bones, spine and joints; belly and head.

When a disease is detected in children, the doctor must strictly monitor the condition, regularly take the necessary tests, based on the results of which the treatment should be compiled and adjusted. In case of pathologies of the hematopoietic system, the child should be under the supervision of a specialist once a week.

How to prepare for the reception and how does it go?

Given the fact that the hematologist treats blood diseases, which will be carefully examined in the future, the patient must undergo certain training - only in this case the doctor can be useful. Moreover, these requirements apply not only to adults, but also to children.

1. Before visiting the doctor, try not to eat for at least 12 hours.
2. Refrain from alcohol and smoking, and if possible - drugs. If you can not limit their intake, be sure to inform the specialist.
3. Reduce your fluid intake the day before your expected doctor's appointment.

What are the benefits of strict adherence to the above rules? First of all, these are the most accurate results of tests, punctures and other medical manipulations. In most cases, treatment to a specialist reveals only diseases that do not require mandatory hospitalization. In such cases, the doctor treats on an outpatient basis. However, it is also closely associated with oncohematology, which deals with malignant pathologies of the circulatory system - leukemia and leukemia.

Directly, a medical appointment is a collection of up-to-date information in accordance with the patient's complaints, if children have problems, the hematologist can draw conclusions from a detailed description of the parents. An initial examination is carried out and a standard blood test is given, including parameters such as hepatitis, HIV, RW, biochemistry. Scheduled diagnostics may include:

• Ultrasound of the lymph nodes and abdominal cavity;
• biopsy of lymph nodes with mandatory histology;
• x-ray of blood of various specifics;
• coagulogram aimed at studying blood clotting;
• morphological examination of the bone marrow with simultaneous taking of a sternal puncture;
• CT - computed tomography;
• scintigraphy or bone scan.

These modern studies make it possible to accurately determine the size and structure of organs, to identify a variety of bone disorders, as well as tumor formations of various localization.

When is a bone marrow puncture required?

A bone marrow examination may be needed only when there is a significant suspicion of blood cancer. This analysis is carried out with a special thin needle, piercing the bone in the sternum or ilium. The selected droplet is subjected to thorough medical research in many ways, which allow you to make an accurate diagnosis and carry out the correct treatment.

To do this, the doctor examines the puncture under a microscope, by analogy with the study of a peripheral blood smear. But in the bone marrow, all types of cells are represented - both very young and mature. If the bone marrow has a normal composition, no additional procedures will be required, and if there are many young cells there, the likelihood of leukemia is high. Or the bone marrow is simply empty - this happens when hematopoiesis is suppressed, and then certain studies will still be needed.

In some cases, a small piece of bone is taken for analysis and, in specially prepared preparations, the structure and ratio of individual elements are studied directly in the bone tissue.

What does a hematologist treat in pregnant women?

For expectant mothers and just women of childbearing age, a logical question may arise: is it necessary to observe a specialist in this profile during pregnancy? It is quite relevant and implies an affirmative answer: a hematologist in an “interesting position” is necessary. First of all, because in pregnant women the number of red blood cells increases many times, which, with the development of the child, increase even more under the influence of the hormone progesterone. An experienced specialist will help keep these processes under control. Among other things, a decrease in hemoglobin can be observed, and this is already a pathological change in pregnancy, leading to an anemic state of the blood, which is very dangerous for the health of the fetus due to lack of oxygen.

Even if a woman feels great, the level of leukocytes in the blood may increase. At first, that is, the earliest stages of pregnancy, the ability of blood to coagulate significantly increases, the level of fibrinogen increases. And just before the baby is born, around the third trimester, there is the highest jump in protein in the blood.

Around the sixth month of pregnancy, the plasma becomes less active and less “friendly” to heparin, and clots and retractions form more quickly. The fibrinolytic process becomes less active immediately before childbirth in order to prepare the body for possible blood loss during the birth process.

Given the above, any blood disorders that can be detected in laboratory tests are a reason to visit a doctor such as a hematologist. And those cases when the consultation is recommended by your attending gynecologist are not even discussed.

A good doctor, or what should a good specialist be like?

Nowadays hematology is the most important aspect of public health in the world community. A doctor going to such a specialization in a medical school enters there not just to treat human diseases, but following a special vocation, because the right of another person to a full life depends on his correct actions.

Given the fact that a hematologist treats, diseases and all kinds of disorders associated with blood are among the most dangerous in the medical environment, a good hematologist must also be an experienced psychologist. Every day he has to face fear and pain that cannot be described. That is why a high degree of responsibility and morality are those ideal qualities inherent in a specialist in his field. A true professional should not only be an “ace” in the field of medicine, who knows the latest innovative methods of research and treatment, but also must be able to subtly feel the state of the person who has addressed him, empathize with him and be able to find the right words in especially difficult cases.