Introduction 2/2/2021
PhD try to investigate mechanisms of leukemia development (originates from blood stem cells).
Inside the cancer cell, mutations, proteins are created, some degraded, some do something to
the DNA. Molecular level he looks at. EMT-happens in solid cancer (brain etc cancers). EMT-big
thing, there are drugs that can block/bindEMT processes. Used ChIP sequencing and that. In
vivo homing-used mice. Leukemia cells activated with fluorescent molecules, inserted into mice,
then looked through machinery through lamps and things where the leukemia cells went into the
mouse. Epigenetics-study of non mutations/modifications of the DNA. UEL research: still on
leukemia, moved away from advanced things to study one cytokine (protein secreted from
immune/non immune cells and activates some cells). This macrophage migration inhibitory
factor is a cytokine that helps cancer development a lot. Block MIF, help body fight the cancer.
TS-transfusion science!
Practical 1 then practical 2 in the morning then afternoon on Feb 23. Last day of practical is
13/4/2021-determination of ABO blood group in your blood! V cool! Week 10 last proper lecture
day. Week 11 we revise and do a practice assessment or whatnot.
Week 12 one assessment; the other assessment a couple of weeks later. With the situation, can
change! C1 (practical assessment): online Moozle quiz-MCQ, fill in the blanks, and short
answers about blood slides-identify and answer questions like which cells are visible/ID
diseases, full blood count evaluation. Short description, not essays; here it is mostly about
describing blood/bone marrow slide and describe the full blood count. Say healthy or diseased.
That is the 12th week, 4/5/2021. C2 (written assessment): answer one long 800-1000 word
essay in 1 hour. Submit it to TurnItIn. Single space! Should be about 2 pages of word file. End of
lectures-will provide examples of questions. One of them will be on the exam!
Biomedical scientists-we are essential!
https://www.pathpedia.com/education/eatlas/histology/bone_marrow/Images.aspx?2 PathPedia
BM Images.
Haematology and Transfusion
Haematology: “Haematology is the study of blood biology (function of blood and blood cells,
generation, destruction) and the diseases associated with its alteration.” The study of blood
components and diseases related to it. Leukemia is a disease treated by haematologists. So
many diseases-haemophilia, sickle cell, anemia, clotting factors and platelets, Von Willebrand
factor, Lupus. Haematology-Study the biology of blood cells (their function, how they are
generated/destroyed) and the diseases associated with the alteration of these cells. Myeloma is
another type of disease-cancer that arises from the B cells. Diseases of WBC, RBC, and
platelets and clotting and coagulation in general. Aims of haematology: ID the disease (means
to recognise the diseases), diagnose, treat the disease and potentially cure the patient.
Lots of people encounter haematologists. Pain, maybe muscle spasms, progressively worse,
blood clot up to lung. Haematology-physician who is an expert in diseases of the blood. These
disorders of blood can be either benign or bleeding problems or clotting problems OR they can
be malignant like leukemias. They do blood tests, results guide them. Haematologist
approaches patient, takes an entire medical history and examines patient and the blood. See
the slide under a microscope. See blood cells, get a history of the patient with lots of
information. Heart pain, bronchitis at doctor. Hospital, says you have a heart attack at 20 years
old. Blood thinners, doing good. Nothing intrinsic to heart is causing problem, problem is in the
,blood. Talked to family and screened them for blood disorders to see if they have the
predisposition to intervene on it before they have the heart attack, which is ultimately the goal.
Kid has a blood disorder his father got from his mum, hereditary spherocytosis. He only had a
couple weeks to live at first. Bleeding disorders were present in most of the patients. They
analysed blood smears under the microscope (used microscopic analysis) to diagnose the
problems.
Clinical Practice Applications of Haematology: Identification and treatment of anemias and
hemoglobin disorders, some genetic others not. Identification and treatment of malignant
(lymphoma and leukemia) and non malignant (leukopenia, leukophilia, etc) diseases of white
blood cells. Malignant-cancerous; that disease is most likely a cancer. Cancers when they
appear do not show a huge flag or anything, is up to clinicians and haematologists to recognise
those things under their eyes are cancer or not. Can be a malignant expansion of cells (or
non)-stated in diagnosis. Identification and treatment of platelet and bleeding disorders such as
hemophilia and idiopathic thrombocytopenic purpura.
Transfusion Science in Clinical Practice Applications: The science of blood transfusion and
the work of a blood bank. Bone marrow and stem cell transplantation.
3 types of Haematology: Clinical Hematology: Haematology related to the patient. Patient
assessment (symptom and signs). Disease diagnosis. Treatment decision. Patient care and
follow-up. Laboratory hematology: Laboratory side. Sample reception, processing and
analysis, like blood biopsies. Disease diagnosis (in clinical and this one). Transfusion laboratory.
Patient Information flow-result of blood analysis and any information. Blood and Bone marrow
bank. Research: Not clinical. Laboratory based science that studies not known stuff yet. Gives
information on genes, proteins, mechanism of disease. Improves current treatment for
haematological diseases or makes new treatments. Biomedical scientists probably in laboratory
hematology and research. Clinical-need medical training and medical degree. The other 2-what
you are studying is needed.
Haematologist Does: Haematologists are specialist doctors who look after and investigate
conditions that are associated with blood and bone marrow problems (where blood cells are
made), including diseases such as anaemia, leukaemia (too many white blood cells) and
haemophilia (blood clotting problems where the blood isn’t sticky enough like haemophilia or
when the blood is too sticky and patients develop clots). Review blood films of patients whose
had some changes in their blood count from their normal; look at the cells and ensure diseases
is not more aggressive or developing into anaemia. There is a balance between looking after
patients and spending time in the laboratory.
Haemato Oncology: Abnormal blood test, see medical oncologist maybe. Specialist in cancer.
Also a hematologist, so any blood disorder. Anemia-give IV iron infusions. Bleeding problem or
blood clotting problem among other disorders. Training: how the blood is to be balanced out.
Good sense of what is normal vs concerning like a blood disorder related to a cancer or
something less serious. Most blood disorders not related to cancers. To understand the type of
disease: 1st step: look at blood in general, including FBC and how it looks under the microscope
and order a few other blood tests. There are different levels of blood analysis, some are easier
like first level (white hat technician). Some analysis need basic ones done first, then doctor will
need additional tests. Be reassured that it is noncancer related problem causing the
abnormality. Iron deficiency anemia or related to another nutritional deficiency or malabsorption
,disorder. Abnormal white blood cells, too high or low, few different causes whether is nutrition,
stress, pain, autoimmune problem, or cancer (least likely problem). Most patients with abnormal
blood test do not have cancer; being a hematologist, more than half do not have cancer. First
thing is get a good medical history, then check some blood work and a lot of times can sort out
the cause of the blood abnormality from those two steps. In haematology, can classify diseases
by cancer related or not. If the alteration is caused by a cancer, is cancer related like myeloma
or that. Not cancer related, may be anaemia or clotting disease. Way to treat them is very
different. Does not mean noncancer related diseases are less dangerous, vast majority is tho,
but some can be v dangerous as well and as deadly. Blood cancers are usually less common
than other cancers in general population (breast and prostate cancer are top leaders). Some
particular stuff in populations like children, leukemia is most common cancers. “Sometimes, the
cancer-side of haematology (cancers arising from the blood cells) is called Haemato-oncology.”
Laboratory Hematology and Pathology: Pathology is a bigger field. Pathology: part of
medicine that studies (observed) how cells, tissues and organs are altered in any disease, and
the means and techniques employed to analyze them. Whenever a disease is accompanied by
some type of alteration, this is very good for medical practitioners and biomedical scientists
because whenever we associate a disease with something that can be seen, is very good
because when we notice that change, we can relate it to the disease. Example-in anaemia,
there is a decrease in the percentage of hemoglobin, which can be seen in machines. So we
see this in any patient, we can get to a conclusion possibly there is anaemia. Aim of pathology
is the study, analysis, and recognition of all these changes that happen inside the body when
there is disease. Aim-diagnosis with pathology (what was just said). Diagnosis: How these
alteration can be detected, analysed, studies with laboratory procedures. Study alterations and
getting to the disease. ID the disease. Look at tissues, cells and all the alterations. Second aim
of pathology is understanding the pathogenesis. Pathogenesis: How the causes (genetic,
biological, environmental, any) of a disease will lead to altered cells and to the development of
the disease. Mechanism through which genetic, biological, and environmental causes lead to
appearance of a disease. Haematology, every case of disease has its own pathogenesis.
Anaemia-causes include iron deficiency, deficiency of micronutrients, low folic acid levels;
autogenesis is the process that leads from causes to the development to the disease. Sickle cell
disease cause-change in the amino acids in the gene (mutations in the DNA). Biomedical
scientists experts in pathogenesis of diseases.
Pathology has a role in the diagnosis of genetic disease (genetics), in cancer (oncology-PAP
smear), infectious diseases (Microbiology), reproductive biology, poisoning diseases (toxicology;
in body after poisoning, is pathology that studies what happened and gives information on the
kind of intoxication), all kind of diseases…and Hematology!
Pathologists: Experts in disease. Work out what is making someone unwell, advise treatment,
and stop others from getting sick in the same way. Work in labs, clinics, and hospital wards.
Every blood test, allergy diagnosis, search for infection involves a pathology team. People who
work in pathology services specialise in particular areas. Anemic-haematologist finds out why.
Lump-histopathologist works out if you have cancer. Chemical pathologist plans treatments for
diabetes. Infection-microbiologist advises if you need antibiotics and which ones. Bridging
science and medicine, pathologists underpin every aspect of patient care, diagnosing, treating
and preventing disease. Key part of a healthcare team. Understand the difference between
, clinical haematology and pathology; pathology can become clinical, if a doctor becomes a
pathologist, but not only a doctor, can also be a biomedical scientist. Pathologist examples:
histopathologist, microbiologist, hematologist, chemical hematologist, clinical, etc. Big family of
different specialisation! Lab hematology is one. Microbiologist. Pathology is a big family of
different specialisations.
Haematology and TS in Research: NOT clinical! Research important for hematology-analysing
blood count of a patient is NOT research. Research has a role in hematology to study affects of
new or rare blood mutations, when looking for new treatments for blood diseases, genome
editing, analyse effects of anaemia in body and how it affects the immune response, finding out
mechanisms of how blood diseases come about. Really is anything about finding something
new, whether it be a mutation or seeing what the mutation causes. “Research on the fields on
hematology and TS is important for the: Understanding of how blood cancers (leukemias,
lymphomas) arise. Discovery, test and optimization of new treatments. Understanding of genetic
mutations in anaemias, leukemias, platelet diseases. Identification of Stem cells, their use and
modification to cure hematological diseases. Improving the tolerance of bone marrow
transfusion. Isolation and creation of alternatives to blood products for transfusion purposes.” Is
for improvement! How diseases arise-pathogenesis. When you do an organ transplantation,
receiver may reject the tissue transplanted. A big part of research is to improve tolerance for
receiving patient. Or isolation in creation of alternative blood products (blood banks short for
transfusions, artificial substitutes on the rise.
Importance of Research: Childhood leukaemia. Lots of causes; major cause is patterns of
infection characteristic of developed societies. We think the problem is lack of infection early in
life. The development of leukemia: babies are in the womb, developing fetuses, there is a
mutation, probably a developmental accident (there is nothing to suggest something from the
outside world causes it). A small percent of them (~1%), get on to get the second mutational
step, sometime after birth, which is believed to be triggered by infection. Medically is an
extraordinary story because it is an intrinsically lethal cancer without treatment. Cure rate now is
90%, alas it is traumatic because it is toxic with long-term consequences for the health of those
children. Is difficult for the children themselves and trauma for the families. What would a parent
prefer? Prevention! Childhood acute lymphoblastic leukemia is probably a preventable disease.
Just give to the infants in their first year of life a safe and benign microbic exposure. Professor
Mel Greaves is optimistic that in about a 5-10 year timeframe this will be translated into some
real benefit.
Acute lymphoblastic leukemia in children. Not talk about curing people, but talked of his effort in
research. Research idea: preventing it by microbial exposure because the cure was invasive
and toxic. Basically wanted a vaccine to expose kids to benign microbes to prevent leukemia
from occurring in children. Developing a disease-pathogenesis, so this guy is studying the
pathogenesis of leukemia in children. Could be a contributing factor, perhaps is absence of
exposure to microbes. This is his IDEA, NOT FACT. Not demonstrated yet. He just thinks if kids
are not exposed to specific microbes, might develop leukemia (hypothesis), if we expose kids
before they develop leukemia, will help body not develop leukemia. Look for a problem, that is
your research topic, finding what has changed or what is different, what is targetable, then come
up with a solution. Not possible to prevent, at least treat the diseases.
