Q1. How do I suspect that I have a blood disorder?
A. Blood is made up of 3 types of cells – red blood cells (RBC), white blood cells (WBC) and platelets – and the liquid non-cellular component of blood called plasma.

Symptoms when there is too much blood (i.e. blood becomes thick):
• Tiredness & fatigue
• Face looks very red and lips look bluish
• Development of blood clots for no apparent reason, e.g. in the legs & lungs (“economy class syndrome”), heart (heart attacks) or brain (strokes)

Symptoms when there is too little blood:
• Lack of RBCs causes tiredness & fatigue, chest pains, headache, hair loss, brittle fingernails or sometimes jaundice
• Lack of WBCs causes fever, chills, shakes (also called rigors), severe infections (e.g. shingles) or repeated infections
• Lack of platelets or plasma proteins causes rashes, bruising or bleeding (including internal bleeding)

Special symptoms that can be associated with blood disorders:
• Enlargement of the glands (lymph nodes) in the neck, armpit or groin
• Enlargement of the liver and/or spleen
• Unexplained bone pain, especially in the elderly
• Unexplained kidney failure and kidney stones, especially in the elderly
• Gout, especially if difficult to control
• Unusual skin rashes or jaundice (yellowing of the white of the eyes)

Q2. Are all blood disorders cancerous?
A. Certainly not. Most blood disorders are not blood cancers. Conditions like iron deficiency anemia can be due to problems with our diet. Blood cancers are broadly called leukemia, lymphoma and multiple myeloma.

Q3. What is a bone marrow test?
A. The bone marrow is the inside substance of certain bones of our skeleton – e.g. hip, spine or thigh bone – that produces blood. You might want to think of it as the factory that produces our blood. In certain blood disorders, the bone marrow factory is faulty and does not produce good blood. The Hematologist will need to test or examine the bone marrow cells under the microscope to determine what is wrong with blood production by the bone marrow.
In order to do this test, a sample of bone marrow must be obtained using a special needle that is inserted into the bone. This is usually done on the hip bone. The procedure is very simple and safe when performed by a trained Hematologist. A local anesthetic is used and if you prefer to sleep during the procedure, sedation can also be given so that the whole procedure is painless. It takes only about 10 mins to obtain all the bone marrow samples (1 mL to 20 mL) required for the test.

Q4. What is a bone marrow transplant?
A. A bone marrow transplant (BMT) is not the same as a bone marrow test. Firstly, the purpose of a BMT is treatment whereas a bone marrow test is for diagnosis. Accordingly, the volume of bone marrow that is collected for BMT is far greater (500 mL to >1,000 mL) than that for diagnostic testing. The collection of bone marrow is also called bone marrow harvesting. This is performed under general anesthesia (GA) in the operating theater (OT). The person undergoing bone marrow harvesting is not necessarily the patient; he/she could be a normal healthy donor. Transfusion of the harvested bone marrow into the patient is called bone marrow transplantation (BMT). Because the bone marrow is a rich source of blood or hematologic stem cells, it is also called hematologic stem cell transplantation (HSCT). When patients donate bone marrow to themselves it is called an “Autologous” BMT; whereas when normal donors donate bone marrow to a patient it is called an “Allogeneic” BMT.

Q5. Can you explain what the 3 types of blood stem cells are?
A. There are many types of blood stem cells but we commonly know 3 of them by their sources. Namely (1) bone marrow stem cells (BMSC), (2) peripheral blood stem cells (PBSC) and (3) umbilical cord blood stem cells (UCBSC). The home of all blood stem cells is the bone marrow. Hence, BMSCs are the most abundant and can be obtained by a process called bone marrow harvesting. Typically, 1 bone marrow harvesting provides sufficient stem cells for 1 stem cell transplant. Stem cells are also found in our blood stream and their numbers can be increased by treating the patient with chemotherapy and/or growth factors. A machine called a cell separator is used to harvest PBSC from the blood stream. The process is called apheresis and typically this needs to be done for 3 to 5 days in order to obtain sufficient stem cells for 1 stem cell transplant. Finally, stem cells are also found in a baby’s placenta. This can be collected at the time of delivery. Unfortunately, there is a limited (about 10-fold fewer) supply of stem cells from the cord blood, such that the largest adult patient that can be treated using a single UCBSC unit is one weighing 44 kg. Larger adult patients will require 2 or more UCBSC units that are pooled together.

Q6. Tell me more about Targeted Therapies for cancer?
A. Traditionally, cancer is treated using surgery, radiation, chemotherapy and stem cell transplantation. Although some selectivity in treatment is possible when the cancer has not spread, standard treatment of widely-spread (metastatic) cancer using chemotherapy and/or stem cell transplantation damages both cancer as well as normal cells. This is fairly toxic. Targeted Therapies are modern therapies that use “smart bombs” to target the cancer cell but spare the normal cell. They are highly-effective and far less toxic than chemotherapy. Hence, treatment outcome is not only improved but tolerance to treatment and quality of life are both enhanced.

Q7. What is Thalassemia?
A. Thalassemias are hereditary (genetic) disorders of hemoglobin. Hemoglobin is the “red” substance in red blood cells that carries oxygen. There are many types of Thalassemia which are divided into 2 broad groups – alpha and beta. In alpha Thalassemia, there is a decrease in the amount of the alpha protein (alpha-globin) of hemoglobin. Similarly, in beta Thalassemia, there is a decrease in the amount of the beta protein (beta-globin) of hemoglobin. Some patients with Thalassemia require regular blood transfusions because they do not have sufficient hemoglobin. Patients with Thalassemia frequently have too much iron in the bodies and this should be removed to prevent long-term ill effects. These blood disorders are transmitted genetically from one generation to the next. I would advise any person with Thalassemia to be on regular follow-up with a Hematologist.

Q8. I have a low platelet count, is this dangerous?
A. Platelets are tiny cells found in blood that participate in blood clotting. Both the number and function of platelets are important in preventing and stopping bleeding. Normal platelet count is between 140,000/µL and 400,000/µL. If platelet function is normal, it is unlikely that bleeding will occur due to a low platelet count if the platelet count is more than 100,000/µL. If the platelet count is below 50,000/µL, spontaneous bleeding might occur and this can be dangerous. I would advise any person with a low platelet count to be on regular follow-up with a Hematologist.

Q9. What is blood component therapy?
A. Blood is a precious material in saving lives. In the modern practice of blood transfusions, blood that is obtained from normal healthy donors is separated into different components. Typically there are 3 components: (1) red cells, (2) plasma and (3) platelets. This is done using a blood centrifuge. When patients have anemia, only red cell transfusions are required. In some patients with bleeding disorders, plasma transfusions can be life saving. Patients with dengue fever might require platelet transfusions. Thus, 1 donor can save 3 lives; improving on the effectiveness of donated blood.

Q10. I have been asked to donate Cell Separator Platelets (CSP), what is this?
A. When normal healthy donors donate their blood, it is separated into different components. One of these blood components is platelets. Typically, 4 to 6 bags of platelets are used each time a person needs a platelet transfusion, e.g. for dengue fever. This means that 4 to 6 donors are required to donate platelets each time a person uses platelets. If there are 10 persons requiring platelet transfusions that day, 40 to 60 donors are required. This puts a great demand and stress on the supply of blood and platelets by the Blood Bank. To improve on this, a special machine called a cell separator can be used to collect only platelets from a donor. This special bag of cell separator platelets (CSP) from 1 donor is equivalent to about 6 bags of normal platelets. Thus the effectiveness of platelet collection is improved by about 500%. Typically 1 bag of CSP from 1 donor is sufficient for a single use. Donation of 1 bag of CSP takes about 2 hours and is performed in special centers called Apheresis Centers.