Haematology deals with the diseases of the blood, bone marrow and the lymph nodes. It includes cancers like leukemia, a type of blood cancer; lymphoma, cancer affecting the lymph glands and myeloma, cancer of the immune cells. Non cancer diseases of the blood include bone marrow failure (Aplastic anaemia), anaemia due to inherited disorders like thalassaemia, sickle cell anaemia and bleeding disorders like hemophilia and immune thrombocytopenic purpura. It is a branch in which molecular medicine is applied in the day to day practice. Bone marrow transplantation is a lifesaving treatment for many of the hematological disorders and solid tumors.
Department is the first of its kind in southern Tamilnadu. It was started in September 2013, headed by Dr.T.Kasi Viswanathan. He did his training in haematology and haematopoietic stem cell transplantation(BMT) from Christian Medical College Vellore. He is supported by well-trained haemato-oncology nurses, medical officers and other paramedical staff. Medical oncologist (Dr.Krishna Kumar Rathnam), Radiation Oncologist (Dr.Kirushnakumar and Dr.Anandaselvakumar) and Pathologists (Dr.Anil Malleshi, Dr.Madhusudhanan and Dr.Sivakami) give their support in the care of patients.
An eight bedded general ward is dedicated to patients with neutropenia. Neutropenic patients are prone to develop opportunistic infections like candidiasis, fungal pneumonia, pneumocystis carinii pneumonia, Cytomegaloviral infection, etc.
Hence these patients are kept in a separate ward with minimal traffic of relatives. There are eight HEPA (High efficiency particulate air) filtered private rooms which is used to isolate severely neutropenic patients (Absolute Neutrophil Count <200). HEPA filter removes particulate materials which are larger than 2 micron, thereby filtering fungal spores from the inhaled air.
- OPD: Monday-Saturday daily from 9am to 6pm.
- Day care chemotherapy
- Day care bone marrow aspiration and biopsy
- Lumbar puncture for CSF analysis and intrathecal instillation of chemotherapy
- Bone marrow transplantation
- 24 hours blood bank with availability of all blood components (Packed red cells, Fresh frozen plasma, platelet concentrates, cryoprecipitate, single donor platelets, granulocyte collection and stem cell collection and storage of cryopreserved stem cells at-80 C)
- Cytogenetic, flow cytometry and molecular studies done at reputed institutes (Tata Memorial hospital, Mumbai, Christian medical college, Vellore and Ranbaxy lab, Mumbai).
- Radiation therapy
- Inpatient general ward, private rooms, deluxe rooms, Special ward for neutropenic patients.
- HEPA filtered rooms.
- Apheresis machine (Fresenius Kabi) used for peripheral blood stem cell collection, single donor platelet collection, Granulocyte collection and plasmapheresis.
- Multispeciality consultations round the clock with 24 hour emergency services.
- 24 hour biochemistry, pathology and microbiology laboratory (NABL accredited).
- Complete coagulation workup (Factor assays) can be done at our lab round the clock.
Diseases Treated in the Department include:
Leukaemia Acute: Acute Lymphoblastic Leukaemia
Acute Myeloblastic Leukaemia
Chronic: Chronic myeloid leukaemia
Chronic Lymphocytic Leukaemia
Chronic myelomonocytic leukaemia
Myeloma and related plasma cell dyscrasias:
- Multiple Myeloma
- POEM’s syndrome
- Polycythemia Vera Rubra
- Essential Thrombocythemia
- Primary Myelofibrosis
- Myelodysplastic Syndromes
- T Lymphoblastic Lymphoma
- Diffuse Large B cell Lymphoma
- Follicular Lymphoma
- Burkitt Lymphoma
- AIDS associated lymphomas
- Waldenstrom’s macroglobulinemia
- Anaplastic large cell lymphoma
- T cell NHL
- Hairy cell Leukaemia
- Cutaneous lymphomas
- Aplastic anaemia
- Myelodysplastic syndrome
- Immune thrombocytopenic purpura
- Auto immune haemolytic anaemia
- Evan’s syndrome
- Haemolytic anaemias like Thalassaemia, sickle cell anaemia, hereditary spherocytosis, etc.,
- Haemophilia A and B
- Other coagulation factor deficiency
- Platelet function disorders
- Glanzman’s thrombasthenia and Bernaud solier syndrome
- APLA syndrome
- Paroxysmal nocturnal hemoglobinuria
- Hyper coagulable states
- Deep vein thrombosis and pulmonary thromboembolism
- Thrombotic thrombocytopenia purpura/ Haemolytic uremic syndrome
- Primary immune deficiency disorders
Many of the patients with haematologic disorders (Leukaemia, lymphoma, myeloma and aplastic anaemia and bone marrow transplantation) have to undergo treatment which involves huge cost. Many among these patients belong to the low socioeconomic status. However with adequate treatment there is a high chance of cure. Hence we support such patients with high cure rates, by providing financial assistance. We mobilize funds from the chief minister’s health scheme, Prime minister’s national relief fund and from newspaper advertisement. This goes a long way in helping the family to cope with the treatment.
1. What is bone marrow transplantation (BMT)? Is it same as haematopoietic stem cell transplantation (HSCT)?
BMT takes cells from inside the bones from a healthy person and gives them to the person who is sick. The bone marrow is where the white blood cells, RBC and platelets are made. Bone marrow transplants are done for people with leukemia, thalassaemia, myeloma and aplastic anemia.
Treating the disease
First, the bad bone marrow that has caused the disease, like leukaemia, must be killed/destroyed to get rid of the bad cells. This is done with large doses of chemotherapy (drugs).
Getting new cells - from relatives
Then the transplant can start. Bone Marrow Transplants come from a living person who is called the donor, this is often a relative – a small procedure takes some cells from the healthy person's blood or bone marrow to give to the sick person. This is an allogenic transplant. The good donor cells are given to the patient though a needle in the arm – just like a blood transfusion.
Getting new cells – from the patient
Some transplants take the patient’s own cells – this is an autologous transplant. This is done if there is no relative with blood like the patient’s blood (no match). First the patient has chemotherapy to get rid of the bad cells causing the leukaemia. When the disease is in control after initial chemotherapy (drugs), stem cells are taken out (separated). Autologous transplants are done mainly for patients with multiple myeloma.
The very young cells in the bone marrow having the capability to continuously multiply and give rise to normal blood cells are called stem cells. Such cells if collected from the donor bone marrow it is called BMT. If such cells are collected from the donor blood it is called peripheral blood stem cell transplantation. Hence HSCT is a more apt terminology rather than BMT.
2. Is blood cancer curable?
A big “Yes”. The advances in medicine in the last 3 decades have revolutionized the treatment of cancers. There are novel targeted therapies which specifically target only the bad cells, sparing the normal cells of the body. This helps in avoiding the dangerous side effects of chemotherapy drugs. Younger the age and early diagnosis, better is the survival. Infact childhood blood cancers have cure rates >85%, i.e., 85 out of 100 children with blood cancer are completely cured of their disease with adequate treatment. In adults and older patients the cure rate for blood cancer is approximately 60%. Imatinib is the first targeted therapy used in the treatment of a specific type of blood cancer called Chronic Myeloid leukaemia (CML). Prior to the advent of imatinib the only hope of cure for CML patients was BMT. Imatinib is a simple once daily tablet which has cured thousands of people with CML. Similarly there are many more novel targeted therapies for caner.
3. Who benefits from bone marrow transplantation?
- Aplastic anaemia (Bone marrow failure)
- Thalassaemia (Inherited disease causing anaemia)
- Recurrent blood cancers (Leukaemia)
- Recurring Lymphoma
- Solid tumors like Neuroblastoma, Brain tumors and breast cancer.
4. Is treatment of cancer (chemotherapy) painful?
No. Cancer treatment with drugs or radiotherapy is not painful. Sometimes due the side effect of the drugs or radiation the person may have pain. However, there are wide rages of effective pain medications to eradicate pain. Patients should be aware of this fact and should report any pain to the doctor, so that the doctor can appropriately help the patient.
5. Will fertility be preserved after chemotherapy? How to overcome the problem?
Certain high dose drugs can affect the fertility. There are facilities to store the sperms in case of males and oocyte in case of females, which can be used at later date.
Contact No: 0452-426 3000 Extn. 3539
- Dr. Kasi Viswanathan, M.D, D.M, - Consultant