Hematology FAQs

Clinical analysis laboratories express the results in figures, accompanied by the normal range for the analyzed parameter. The normal intervals or reference values ​​vary between each laboratory and, in general, they tend to be quite wide. When a result deviates from the reference values, it is said to be abnormal.

Frequently, the small variations with respect to the reference values ​​are not usually important and a healthy person can have one or more values ​​that deviate from the normal limits without this implying that they have a disease. Hematologists are the specialists with the most experience in interpreting the results of blood tests

Ferritin is the cellular protein responsible for the body's storage or deposits of iron. Normal blood ferritin levels at the upper limit of normal are considered to be 300 ng/mL and 200 ng/mL for men and women, respectively. This can increase in the case of processes or diseases that occur with inflammation, regardless of the cause that originates it (rheumatic inflammatory diseases, infections and various chronic diseases).

Therefore, the first diagnostic approach to an analysis that shows a significant increase in ferritin is to interpret whether it is an increase secondary to an inflammatory process, or if, on the contrary, it is an increase caused by a mutation or mutations of a gene called HFE. Hereditary hemochromatosis, a disease that produces an abnormal accumulation of iron that causes damage to the tissues where it is deposited, is caused by mutations in the HFE gene. These mutations produce an increase in the intestinal absorption of iron, with the consequent risk of producing an overload in the organism.

Mutations in this gene are common in the general population (4-5% in individuals of European descent) and their presence does not necessarily mean that these people develop iron overload in tissues or organs (liver, joints, pancreas, heart). The hematologist establishes the cause of the increase in ferritin and its possible implications for the patient's health.

The organism has a dynamic and changing behavior depending on many circumstances, both physiological and pathological. The results of blood tests in a person may present variations that reflect physiological changes (pregnancy, physical exercise, stress, etc.) or changes due to exposure to certain toxic substances, such as alcohol or tobacco.

Leukocytes or white blood cells are the best example of how a certain type of blood cell can fluctuate in certain circumstances, such as diet or changes in the natural rhythm of sleep or wakefulness. Various studies have shown that the number of leukocytes can experience changes during the day in the same individual of up to 800 elements per cubic millimeter (the normal number of leukocytes is 4,000 to 11,000 per cubic millimeter).

On the other hand, and in relation to the changes observed in a certain value, the preanalytical variables must be taken into account, that is, those factors that intervene from the extraction to the analysis of the sample in the laboratory (difficult blood extraction due to accessibility of the veins, transport, storage and time until processing), as they can influence changes in the figures of successive analyzes in the same individual, even in a short period of time.

An increase in the total white blood cell count (called leukocytosis) in a test can be caused by multiple factors. It is necessary to distinguish what type of leukocyte is increased. There are 5 normal types of leukocytes: neutrophils, eosinophils, basophils, lymphocytes and monocytes, each with its normal number expressed in reference values ​​and with a specific function.

Thus, and schematically, neutrophils are leukocytes that assume a defensive function against bacteria, eosinophils are related to allergic reactions, lymphocytes are blood cells that have an immune function, and monocytes act in inflammatory and infectious.

The causes of the increase in the number of leukocytes can be multiple, and in general, the most frequent are usually secondary, that is, caused by various circumstances. Among them, infections, smoking, chronic inflammatory diseases or even some drugs such as corticosteroids are frequent.

On the other hand, when there is apparently no secondary cause, a persistent or progressive increase in the number of leukocytes can lead us to suspect the existence of a leukemic-type blood disease, such as chronic lymphatic leukemia, in the event that the increase observed in the absolute number of lymphocytes. Clinical hematologists establish the origin of leukocytosis, its diagnosis and meaning.

The appearance of blood spills on the skin without apparent trauma is a relatively frequent consultation in Hematology. There are 3 types of skin bleeding that must be distinguished from each other.

Petechiae are pinpoint hemorrhages, reddish in color and small in size, which appear with greater incidence in the lower extremities. In most cases they are related to a decrease in the number of platelets. Hematologists call purpura the skin lesion resulting from the presence and confluence of numerous petechiae.

Ecchymoses consist of an extravasation of blood into the subcutaneous tissue that does not cause relief in the affected area and is colloquially known as a "spill" or "bruise".

Hematoma is a voluminous collection of blood that settles in soft tissue, such as muscle. The presence of bleeding in the skin does not necessarily mean the presence of a serious hemorrhagic disease.

The presence of more or less extensive ecchymoses on the back of the hands and forearms is common in elderly people with greater fragility of the epidermis accentuated by excessive exposure to the sun. Depending on the characteristics of the lesions and the laboratory values, clinical hematologists guide the cause of skin bleeding.

The appearance of an abnormal protein in a blood test carried out in a routine control or for another reason is a common consultation in Hematology. When the analysis of blood proteins or proteinogram is requested, the presence of an abnormal protein or monoclonal band may be discovered by chance, which the clinical analysis laboratory notifies by means of a message indicating its existence.

The first step is to confirm its presence and identify the type of abnormal protein. Monoclonal proteins or monoclonal gammopathies are frequent in the general population and their incidence increases according to the patient's age, being more frequent the older the individual is. In most cases, its clinical course is indolent, without causing any alteration in the patient.

However, and it is quite common, that the patient who comes for this consultation has tried to find out on his own the meaning of this finding and expresses his fear that it is a bone marrow tumor process called myeloma, since the information respect in the network is biased and little explanatory.

The vast majority of monoclonal gammopathies are not synonymous with a tumor process, but a series of analyzes and adequate explorations must be carried out to investigate the type and importance of the abnormal protein.

Iron deficiency is the most common cause of anemia. Iron deficiency anemia, that is, anemia caused by iron deficiency, must be distinguished from iron deficiency without anemia, a situation in which the hemoglobin level (the objective indicator of anemia) is normal, but iron stores are low or missing.

The highest prevalence of iron deficiency anemia and iron deficiency is observed in females, as it is associated with the period of fertility (menstruation and pregnancy). One in five women will develop iron deficiency anemia or iron deficiency throughout her life. Diagnosis is relatively simple with a good medical history and assessment of the main indicator of body iron stores, ferritin. In women of childbearing age, the most common causes are menstrual loss and pregnancy. However, when iron deficiency anemia or iron deficiency appears in a menopausal man or woman, the diagnostic orientation varies completely and it is generally accepted that until the contrary is proven, the cause is originated by blood loss. 

GI blood loss, overt or occult, is the leading cause of iron deficiency and iron deficiency anemia in Western countries in men and postmenopausal women. In this context, the hematologist frequently indicates digestive endoscopic examinations (fibrogastroscopy and/or colonoscopy) or other studies to find out the cause and plan specific treatment.

A decrease in the normal white blood cell count (minimum reference value: 4,000/mL) is a common finding in people undergoing routine periodic screening or for other circumstances and is called leukopenia.

Neutropenia in adults is defined when the number of neutrophilic granulocytes is less than 1500/mL. Leukopenia is often accompanied by neutropenia. Hematologists categorize neutropenia as minimal if the number of neutrophilic granulocytes is between 1,000 and 1,500/mL, moderate between 500 and 1,000/mL, and severe if the number is less than 500/mL. In addition, we consider it chronic if it persists for more than 3 to 6 months.

The most frequent causes of leukopenia and neutropenia are viral infections and drugs, such as antithyroid drugs, anti-inflammatories, antidepressants, various drugs with cardiovascular action and some antibiotics, in addition to an extensive and endless list of drugs in which neutropenia has been described as an adverse phenomenon. Various hematological, rheumatological and autoimmune diseases can also cause neutropenia of greater or lesser intensity.

However, idiopathic or benign chronic neutropenia is very common and is diagnosed when there is no apparent cause, being a frequent consultation in Hematology. It is important to emphasize to the patient that only severe neutropenia predisposes to greater susceptibility to infectious diseases, since in minimal or moderate neutropenia this predisposition to infection does not occur.

Oral anticoagulants are drugs that prevent the physiological mechanism of coagulation and are used in most cases to prevent thrombosis and embolism, but also in other circumstances in which it is essential that the patient is anticoagulated regularly. indefinite. Schematically, 2 types of drugs are used.

In the first place, we have anticoagulants that prevent the formation of coagulation factors synthesized in the liver and that are dependent on vitamin K (they are called dicoumarins and are antivitamin K). Acenocoumarol (Sintrom) and Warfarin (Aldocumar) are the two most used drugs in this group of anticoagulants.

Secondly, we currently have other so-called direct-acting anticoagulants (DOACs), which prevent coagulation by acting in its final phases, without depending on the synthesis of coagulation factors by the liver. Today there are various preparations in this group, such as dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Lixiana).

The advantages of Sintrom and Aldocumar are based on their many years of experience in use, indication in certain situations such as mechanical heart valve prostheses where DOACs are not authorized, on their rapid reversibility with vitamin K and on the fact that the intensity of anticoagulation through a test called INR, as well as its very low economic cost. On the contrary, its main disadvantages lie in the need for periodic (monthly) control, in the modification of its effect by diet and its possible variations by taking other drugs.

The main advantage of DOACs is the absence of regular monitoring of the degree of anticoagulation, and their lower degree of interactions with other drugs, unlike what happens with Sintrom. On the contrary, its main disadvantage in relation to Sintrom is its price, since certain medical indications are not financed by the public health system, which can represent a significant monthly economic burden for the patient.

DOACs have been shown in clinical trials involving thousands of patients to be at least as safe as dicoumarins and to have a lower incidence of bleeding, even without requiring regular monitoring of the degree of anticoagulation. The clinical hematologist can advise the patient which may be the best option in their particular case, discussing the advantages an

The term adenopathy is used to indicate an increase in the size of the lymph nodes, whatever its origin. Lymph nodes are generally a maximum size of 1 centimeter and, therefore, the term adenopathy indicates an increase greater than this measurement. A common consultation in Hematology is the appearance or self-observation of the presence of adenopathy in the neck region (cervical adenopathy).

After questioning the patient about the existence of a possible recent infection or about the presence of any known disease that could explain it, the hematologist performs a careful and detailed physical examination to determine the characteristics of the adenopathy (size, consistency, mobility with respect to planes). deep) and if more adenopathies are palpated in other lymph node territories, such as the armpits and the inguinal region, as well as the presence of an enlarged spleen (splenomegaly), since the spleen is considered an organ of the lymphoid system.

In the case of cervical adenopathy, the cause may be reactive to a virus infection, to a dental process, or it may be the expression of a primary hematological tumor (lymphoma) or the first manifestation of a solid tumor (cancer of the head and neck, esophagus, etc.), among various causes.

The diagnosis is based on multiple factors, including the presence of a single or multiple adenopathies, in the anatomical territories where they are located, in the clinical history and the symptoms that the patient may show, such as fever, weight loss, night sweats , etc, and in the results of analysis, imaging techniques (ultrasound, CT, magnetic resonance) and, if necessary, in the biopsy of the adenopathy. The most important thing is to differentiate between benign and malignant causes, and a biopsy of the lymphadenopathy should not always be carried out immediately, since, on occasions, vigilant observation of its natural course (decrease, disappearance or increase) can establish the attitude to follow.

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