For the love of blood

Haematology is the study of blood. The work of a laboratory haematologist focuses on diseases affecting the blood. When investigating blood disorders a Haematologist may also examine the production of blood cells, which takes place in the bone marrow.

Haematologists supervise the processing of blood cells for transfusion, stem cells for transplantation, and are involved in cross matching blood for thousands of patients every year across Australia. They diagnose and treat clotting and bleeding abnormalities, conduct red cell antibody screens during pregnancy, and manage genetic and acquired blood diseases.

However, as the blood system is involved in almost every medical condition, haematologists can also contribute to the diagnosis and management of almost any disease or disorder throughout the body.

We asked Dr Ellen Maxwell about her role as a laboratory haematologist:

  1. What made you decide to specialise in Haematology?

I was rotated through the Haematology ward in my second resident year.  I had great mentors, enjoyed the complex medicine and bonded with many patients on the ward.  I felt encouraged in my pursuit of knowledge and valued in my contribution to the unit.  In short, they won me over.

Although I loved working with these patients, I also loved the puzzles of numbers (patient results) and had a particular flair for morphology (looking at cells and making diagnoses with the microscope). I always enjoyed and was good at jigsaws!

  1. How many hours do you work in a typical week?

The kids are at school by 8 so the day usually starts then. I often head home about 7:30, but evening meetings are not infrequent. I have a very supportive husband who was a stay at home dad when the kids were small, otherwise it would have been impossible.

There are on-call commitments approximately 1-2 weeks per month (24/7). Some weeks are very quiet but when it rains it pours and you may be up co-ordinating a massive blood transfusion in the middle of the night or sending a newly diagnosed acute leukaemic patient to hospital at midnight if they are at risk.

  1. What does a typical week involve?

My work includes:

  • Diagnostic work; reporting blood films and bone marrows as well as other abnormal test result interpretation
  • Performing bone marrow biopsies
  • Giving clinical advice by phone based on abnormal test results
  • A role in patient therapy including managing transfusion problems, running an anticoagulant clinic and a therapeutic venesection service
  • Teaching medical students, scientists, hospital staff and general practitioners
  • Supervising advanced Haematology trainee projects and conducting my own research
  1. What makes your job enjoyable?

I always tell my medical students that they won’t find a more holistic branch of medicine.  Nowhere else do you get to meet a patient, take a history, perform an examination, procure the diagnostic specimen, review, interpret and report it, predict the clinical outcome, take the information back to counsel the patient, treat and watch their progress. Pathology is central to every diagnosis that a clinician relies on. Each year is peppered with new diagnostic challenges and medical advances.

  1. What kind of contact do you have with patients? Is this different to other areas of pathology?

Like me, many Clinical pathologists, microbiologists and chemical pathologists, have completed training through the College of Physicians as well as pathology training. That’s about 7-8 years of further study after your medical degree. During that time there is patient contact as part of ward service or outpatient clinics. This is different to Anatomical pathologists who usually enter pathology training after fewer clinical years and then work only from within the laboratory liaising mostly with medical referrers.

In my current role, I physically interact with patients (and their relatives) when I attend for bone marrow biopsies. You get to know a little about them personally; about their disease and progress as well as their social and emotional issues. You need the skill to make them confident in your expertise to look after them through the procedure, and provide a high quality result. Developing a relationship of trust is pivotal to this, I talk to them throughout the procedure.

I frequently speak to patients about their anticoagulation and I provide education to patients at talks and public forums. Clinical pathologists of all disciplines have conversations with patients, either initiated by patients or as part of organised education meetings.

  1. What are the most common conditions that you deal with?

There are malignant conditions both haematological and non-haematological that affect bone marrow and blood e.g. leukaemia, metastatic cancers. There are also issues like investigation of anaemia and other low blood counts, transfusion and patient blood management, antenatal care, management of anticoagulation, investigation of bleeding or excessive clotting disorders, as well as diagnosis of thalassaemia.

  1. What about rarer conditions?

Examples of interesting diagnoses include development of antibodies within a patient that are directed against their own clotting proteins, rendering them at high risk of bleeding. These occur at a frequency of about 1 per million of the population and we see this at our laboratory at least a couple of times a year. It needs urgent recognition and intervention.

Unfortunately, some of the fascinating and most spectacular abnormalities you see down the microscope are often the less desirable diagnoses for patients. However, it’s great when you’re expecting the worst and then get a better outcome.

  1. What has been your favourite moment working in pathology?

We are always chuffed when there is any recognition of how critical our role is and how hard our team, including collectors, couriers, scientists and results staff, are working to achieve the best outcome for the patient. Pathologists (and their supportive lab staff) are so invisible that compliments are few and far between, but also not really expected. We had a poignant moment recently when a father rang to say how grateful he was that we cared enough to chase the family down, even though very  late, to get their child with a new acute illness (leukaemia) to hospital for prompt diagnosis and intervention. That’s what we’re trained to do.

Image credit: Royal College of Pathologists of Australasia