A hematologist is an internist with additional training who specializes in blood diseases. This specialist treats diseases such as anemia, hemophilia and sickle cell disease as well as cancers such as leukemia, lymphoma and multiple myeloma. (See Oncology description within Internal Medicine/Oncology.)
Hematologists are experts in caring for patients with disorders of the blood, bone marrow and lymphatic systems. Nonmalignant blood disorders include bleeding and clotting problems (such as hemophilia and pulmonary embolism) and diseases of red blood cells (such as sickle cell anemia and thalassemia). Malignant blood disorders include leukemias and lymphomas. Causes of these diseases can be genetic factors, medications, patient lifestyle or environmental factors; patients cared for by hematologists span the life cycle from babies to centenarians.
Specialists in hematology can focus their education and practice in many ways. Hematologists who focus on nonmalignant hematology diagnose disorders in their roles as office- and laboratory-based detectives, using critical thinking and problem-solving skills. The required tools include a sound understanding of basic science and pathophysiology, visual competency at the microscope to seek out important morphologic clues on peripheral blood smears, and an ability to analyze lab techniques, including molecular diagnostics. Above all, hematologists must be able to integrate all of this information into a final diagnosis and appropriate treatment plan.
Hematologists may serve as long-term providers to patients with chronic conditions, or they may serve as consultants to physicians and to hospitals in areas including trauma, neurosurgery and cardiovascular disease. Hematologists also screen for blood diseases and can offer preventive services.
Physicians who practice hematology and focus on malignant disorders treat, among other conditions, acute and chronic leukemias and multiple myeloma. Treatment is intensive and requires a broad range of knowledge in other disciplines such as infectious diseases. Treatment for malignant disorders can also include bone marrow transplantation, which can be a career focus itself. Additional career options in hematology include transfusion medicine (which includes therapeutic apheresis and blood banking).
Hematology is an ideal field for the future physician- scientist, whether focused on health outcomes research, clinical and translational research, or basic science research. Hematology is at the cutting edge of medicine and continues its leadership role in translating discoveries about the genetic and molecular origins of diseases into targeted treatments used in the care of patients.
One of the unique facets of the specialty is that hematologic disorders often appear to arise from one of the major organs. And because blood is everywhere in the body, hematologists collaborate in patient care and research with colleagues from many disciplines including cardiology, immunology and infectious diseases, general internal medicine, general pediatrics, and all of the surgical specialties.
Hematologists can enter the specialty having completed a residency in internal medicine or a combined internal medicine/pediatrics residency. Within the specialty of internal medicine, hematology training is most often combined with oncology training; many physicians choose to become board-certified in both hematology and medical oncology. (Physicians interested in the care of children can specialize in pediatrics and subsequently pursue training in combined hematology/oncology fellowships. Hematopathologists first complete a residency in pathology.)