What is Hematology?

Hematology concerns the study of blood, the blood-forming organs and blood diseases. Hematology also includes the diagnosis, treatment, prognosis and prevention of blood diseases, such as lymphoma and leukemia. Dr. Vijay Ramanan is a certified hematologist in Medical Oncology and Hematology. Hematologists may specialize further or have special interests, for example in: treating bleeding disorders such as hemophilia and idiopathic thrombocytopenic purpura treating hematological malignacies such as lymphoma and leukemia treating hemoglobinopathies in the science of blood transfusion and the work of a blood bank in bone marrow and stem cell transplantation

(Hematology comes from the Greek words (''haima'') meaning "blood" and (''logos''), a root commonly employed to denote a field of study.)

At the Ruby Hall Clinic Oncology & Hematology Clinic we work to formulate a diagnosis and deliver the most appropriate therapy if needed for blood diseases. Hematology is a distinct subspecialty of internal medicine, and overlaps with the subspecialty of medical oncology, so we are uniquely trained to deliver the proper treatment.

LYMPHOMA
Lymphoma is not a single cancer but a group of many related cancers--there are nearly 30 different types of lymphoma. Broadly, they are grouped under two categories: Hodgkin Disease and Non-Hodgkin Lymphoma. These two broad groups may be similar in their symptoms and the tests that are required, but they behave differently when they affect a person. Today, primary treatment cures more than 80 percent of patients and significant emphasis is now placed on survivorship. The most recent advance in Hodgkin lymphoma management has come from diagnostic imaging using FDG-PET scans, which are more specific for tumor identification than CT scans.

While the exact causes of lymphoma remain unknown, the following factors increase the risk: older age, being male, of Caucasian race, HIV/AIDs, diet high in meats and fat and exposure to certain

pesticides. Symptoms of lymphoma include swollen lymph nodes in the neck, underarms and groin, fever, weakness and fatigue, weight loss, sweating, difficulty in breathing or chest pain, itchy skin and rash.

To begin treatment, we will perform a lymph node biopsy to diagnose lymphoma. Additional tests are then conducted to determine the stage (extent) of the lymphoma including blood tests, bone marrow biopsies, and imaging tests, such as a CT scan or PET scan. Imaging tests show whether the lymphoma has spread to other parts of your body, like the spleen and lungs. Decisions about treatment are then determined by your doctor, who will consider your age, general health, and stage and type of lymphoma. Hodgkin lymphoma is one of the most curable types of cancer.

Treatment options include the following:

Chemotherapy Chemotherapy and radiation that directly targets the lymphoma Biological therapies, such as antibodies, directed at lymphoma cells Stem cell transplant

For some patients, participating in a clinical trial provides access to experimental therapies. If you are diagnosed with lymphoma, talk with your doctor about whether joining a clinical trial is right for you.

LEUKEMIA
Leukemia is a type of cancer found in your blood and bone marrow and is caused by the rapid production of abnormal white blood cells. These abnormal white blood cells are not able to fight infection and impair the ability of the bone marrow to produce red blood cells and platelets.

Leukemia can be either acute or chronic. Chronic leukemia progresses more slowly than acute leukemia, which requires immediate treatment. Leukemia is also classified as lymphocytic or myelogenous. Lymphocytic leukemia refers to abnormal cell growth in the marrow cells that become lymphocytes, a type of white blood cell that plays a role in the immune system. In myelogenous leukemia, abnormal cell growth occurs in the marrow cells that mature into red blood cells, white blood cells, and platelets. There are four broad classifications of leukemia:

Acute lymphocytic leukemia (ALL) Acute myelogenous leukemia (AML) Chronic lymphocytic leukemia (CLL)

Chronic myelogenous leukemia (CML)

Leukemia occurs in both adults and children. ALL is the most common form of childhood leukemia, and AML is the second most common. The two most common adult leukemias are AML and CLL.

Although experts are uncertain about the causes of leukemia, they have identified several risk factors that include the following:

Exposure to high levels of radiation Repeated exposure to certain chemicals (for example, benzene) Chemotherapy Down Syndrome A strong family history of leukemia

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

Fever, chills, night sweats and other flu-like symptoms Weakness and fatigue Swollen or bleeding gums Headaches Enlarged liver and spleen Swollen tonsils Bone pain Paleness Pinhead-size red spots on the skin Weight loss

Your doctor will conduct a complete blood count (CBC) to determine if you have leukemia. This test will reveal if you have leukemic cells, or abnormal levels of white blood cells; both are signs of leukemia. Abnormally low red blood cell or platelet counts can also indicate leukemia. If you test positive for leukemia, your doctor will perform a biopsy of your bone marrow to determine which type you have.

Treatment depends on your age, general health, and type of leukemia. You might receive a combination of treatments that could include chemotherapy, biological therapy, radiation therapy,

and stem cell transplantation. Patients with acute leukemia often undergo chemotherapy because this type of treatment targets fast-dividing cells. Many acute leukemia patients have responded successfully to treatment. On the other hand, because the cells divide more slowly in chronic leukemia, it is better treated with targeted therapies that attack slowly dividing cells as opposed to traditional chemotherapy that targets rapidly dividing cells.

For some patients, participating in a clinical trial provides access to experimental therapies. If you are diagnosed with leukemia, talk with your doctor about whether joining a clinical trial is right for you.

Because the cause of leukemia remains unknown, there is no certain way to prevent it. However, avoiding exposure to solvents, such as benzene and toluene, and unnecessary exposure to x-rays is generally good practice. If you think you may be exhibiting signs of leukemia, being aware of the risk factors and symptoms and talking with your doctor are critical to early diagnosis and treatment. It is especially important for people who have a family history of leukemia to be aware of symptoms and share their family medical history with their doctors.