Ask Dr. Sachita — Haematology & Blood Cancer Q&A

A haematology opinion is useful when a blood count abnormality persists or is unexplained — anaemia that does not correct, low platelets, low white cells, a rising white cell count, or a combination of changes. It is also appropriate for enlarged lymph nodes, unexplained bruising or bleeding, a suspected blood cancer, an abnormal bone marrow or flow cytometry report, or a clotting problem that needs specialist assessment. Dr. Sachita Baniya (NMC 20158) reviews the full blood count trend, prior reports and clinical context before deciding which additional tests are needed.

A bone marrow aspiration and biopsy is usually taken from the back of the hip bone after local anaesthetic. The aspiration draws a small liquid sample; the biopsy removes a thin core of marrow. Most people feel pressure and brief discomfort rather than ongoing pain, and the procedure takes a short time. It is used to diagnose leukemia, lymphoma, myeloma, myelodysplasia and bone marrow failure, and to monitor response after treatment. Dr. Baniya has performed more than 1,000 bone marrow procedures and explains the steps, aftercare and expected result timeline before the test.

Leukemia diagnosis combines the blood count, peripheral smear, bone marrow aspiration and biopsy, flow cytometric immunophenotyping, cytogenetics, FISH and molecular testing. The subtype — for example AML, ALL, CML or CLL — is defined by the cell lineage, maturation and genetic findings. Risk stratification then guides treatment intensity and whether transplant should be considered. Dr. Baniya reviews these results together because a single test rarely tells the whole story.

Both are acute leukemias, meaning immature cells accumulate in the marrow and normal blood production fails. AML involves myeloid lineage cells and is more common in older adults. ALL involves lymphoid lineage cells and is more common in children, though it also occurs in adults. Treatment differs: AML usually begins with intensive induction chemotherapy, while ALL treatment includes induction, consolidation and prolonged maintenance, with central nervous system prophylaxis. Genetic and molecular features refine both diagnosis and risk.

CML is driven by the BCR-ABL1 fusion gene, and tyrosine kinase inhibitors (TKIs) target it directly. With consistent treatment and monitoring of BCR-ABL1 transcripts, many patients achieve deep molecular responses and remain in long-term control. Response is checked at defined intervals, and treatment may be adjusted for intolerance or resistance. Dr. Baniya reviews adherence, side effects and molecular trends at each visit; treatment should not be stopped without specialist supervision.

Lymphoma diagnosis usually requires a lymph node or tissue biopsy — an excisional biopsy is preferred when feasible because it preserves architecture. Immunohistochemistry, flow cytometry and molecular studies identify the subtype. Staging then uses imaging and, when indicated, bone marrow assessment. Treatment depends on the subtype, stage, symptoms and patient fitness. Dr. Baniya works with pathology and imaging teams to integrate the results before discussing options.

Hodgkin lymphoma has a high cure rate with modern treatment, particularly in early-stage disease. Treatment usually combines chemotherapy with or without radiotherapy, planned according to stage, risk factors and response. Late effects — including cardiac, pulmonary and second-cancer risks — are part of long-term follow-up. Dr. Baniya discusses treatment intent, expected response assessment and survivorship planning rather than offering a guarantee for an individual case.

Myeloma evaluation includes serum and urine protein electrophoresis, serum free light chain assay, immunoglobulin levels, bone marrow aspiration and biopsy with plasma cell assessment, FISH for risk stratification, and imaging for skeletal or extramedullary disease. Blood counts, kidney function, calcium and albumin are also needed. These results establish whether the criteria for myeloma are met and distinguish it from MGUS or smouldering myeloma.

MGUS is a small monoclonal protein without organ damage and is monitored rather than treated. Smouldering myeloma meets some laboratory criteria but has no myeloma-defining organ damage; observation is usual, with treatment considered in selected higher-risk cases. Active myeloma requires treatment and is defined by clonal plasma cells plus organ damage or specific biomarkers. The distinction matters because treating a precursor unnecessarily exposes patients to side effects, while missing active disease delays needed care.

An autologous transplant uses the patient's own stem cells, collected before high-dose treatment and returned afterwards. It is common in myeloma and relapsed lymphoma. An allogeneic transplant uses stem cells from a matched donor and provides a graft-versus-disease effect, but carries risks of graft-versus-host disease and infection. Haplo-identical transplant uses a half-matched family donor when a fully matched donor is unavailable. The choice depends on the disease, risk, patient fitness and donor options.

Eligibility depends on the disease and its risk, the depth of response to prior treatment, the patient's age and organ function, the availability of a suitable donor, and the patient's understanding of risks and recovery. Transplants are considered for selected leukemias, lymphomas, myelomas, myelodysplastic syndromes and bone marrow failure. Dr. Baniya reviews the indication, pre-transplant work-up and expected timeline with the patient and family before referral.

CAR-T therapy engineers a patient's T cells to recognise a specific protein on cancer cells, then returns them after lymphodepleting treatment. It is used in selected relapsed or refractory blood cancers, depending on the disease, target antigen, prior treatments and the treating centre's programme. Patients need close monitoring for cytokine release syndrome, neurological toxicity and infection. Dr. Baniya assesses eligibility, coordinates referral and supports follow-up after infusion.

Seek urgent assessment for fever of 38°C or higher, chills or shaking, new breathlessness or cough, sore throat that worsens, unusual bruising or bleeding, persistent vomiting or diarrhoea, reduced urine output, confusion, or a new rash. Fever during neutropenia can be life-threatening and should not wait for the next clinic appointment. Patients are given a written warning-signs plan and instructed to contact the treating hospital immediately.

ITP is an immune-mediated fall in platelets, causing bruising, petechiae or bleeding, without another obvious cause. Diagnosis is clinical and excludes other causes through blood counts, smear review and targeted tests; bone marrow examination is not routine in typical cases. Treatment depends on bleeding severity and platelet count and may include observation, steroids, intravenous immunoglobulin, anti-D where appropriate and newer agents. Urgent review is needed for significant bleeding or very low counts.

Anaemia is a sign, not a diagnosis. Iron deficiency may result from poor intake, malabsorption or blood loss — including gastrointestinal bleeding — and treating with iron without finding the cause can delay diagnosis. The blood count, red cell indices, iron studies, B12 and folate, reticulocyte count and peripheral smear guide the work-up. Dr. Baniya evaluates the pattern of anaemia and arranges targeted investigation, including haematology referral for suspected marrow disorders.

Cancer and its treatment increase the risk of venous thromboembolism, including deep vein thrombosis and pulmonary embolism. Clot risk varies with cancer type, stage, surgery, hospitalisation and systemic therapy. Anticoagulation is used for treatment and sometimes prevention, balanced against bleeding risk and drug interactions. Dr. Baniya assesses thrombotic and bleeding risk with the oncology team and reviews anticoagulant choice and duration.

Yes. A second opinion is reasonable when the diagnosis is complex, pathology is uncertain, treatment options are closely balanced, or a transplant or CAR-T decision is being considered. The most useful review includes the bone marrow report and slides where available, flow cytometry, cytogenetics, molecular results and imaging. Dr. Baniya reviews the records, explains areas of agreement and disagreement, and provides a written summary that can be shared with the treating team.

Bring the referral letter if you have one, all recent blood count reports with dates, prior bone marrow and flow cytometry reports, cytogenetics and molecular results, imaging reports, a current medication list including supplements and blood thinners, and a summary of your symptoms and their timeline. If a family member attends, they can help recall details. For transplant or CAR-T discussions, bring prior treatment summaries and donor information if available.