Diagnostic Hematology

Hematology is difficult to teach at the medical school level. The curriculum is necessarily fragmented across different years of study, and often separated considerably in time. Understanding hematology requires insight into several distinct aspects: applied physiology (generally taught early), an understanding of the essential pathological processes involving the blood are taught somewhat later (if at all), and the (necessarily) strong laboratory aspect is generally taught more or less concurrently with other clinical pathology topics, such as clinical chemistry and immunology. By the time the student is faced with blood diseases in the wards, the laboratory/pathological bias is well entrenched. It is thus difficult for the student to get an integrated view of the subject. The unspoken assumption, often reinforced by clinical tutors trained in the traditional perspective, is that blood tests are all that are required for a diagnosis in blood diseases. The result has been that clinical expertise in blood diseases is generally poor. This is reflected in the importance given to the examination of the hematological system in most student primers.The hematological system, by and large, is almost completely neglected. Such relevant features such as pallor, jaundice, bleeding, splenomegaly and so on are dealt with either in passing or in relation first to another system or the 'general examination'. It is almost as though it is taken for granted that the haematological system cannot be assessed clinically - and yet, as demonstrated later in the book, it is in very many cases impossible to reach a complete haematological diagnosis without clinical assessment. Effective, patient-centred care of hematological patients requires, as with all other patients, a comprehensive clinical insight into these disease processes, i.e. an integrated clinical and pathological approach.