Recent advances in haematologyBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7189.991 (Published 10 April 1999) Cite this as: BMJ 1999;318:991
- Drew Provan (email@example.com), senior lecturer in haematology,
- Denise F O'Shaughnessy, consultant haematologist.
- Department of Haematology, Southampton General Hospital, Southampton SO16 6UY
- Correspondence to: Dr Provan
Haematology is a diverse specialty embracing clinical and laboratory aspects of adult and paediatric disease, both malignant and non-malignant. We describe here some of the progress that has been made in diagnostic and therapeutic strategies. Molecular advances are continuing at a phenomenal rate (exceeding the rate of progress in therapeutics), offering highly sensitive methods for disease detection and, in some disorders, prospects of cure through gene therapy.
We used information from recent key meetings, including those of the British Society for Haematology and the American Society of Hematology; leading articles in major haematology journals; and discussion with colleagues. The choice of topics covered is largely personal, and owing to space restrictions we have not included every “advance” within the specialty.
Distinguishing between anaemia due to iron deficiency and anaemia of chronic disease is a difficult but common problem in medical practice. Anaemia of chronic disease is complex and involves inflammatory cytokines,1 reduced marrow response to erythropoietin, reduced red cell life span, and impaired reuse of iron.2 In typical, uncomplicated iron deficiency anaemia the haemoglobin concentration, mean cell volume, and serum ferritin and iron concentrations are reduced with raised total iron binding capacity; unfortunately cases are often not typical, and the results of these tests may seem conflicting. Furthermore, if a patient with anaemia of chronic disease is also iron deficient, the parameters for diagnosing iron deficiency are altered, making the diagnosis difficult; often a bone marrow aspirate, stained for iron, is the only method for accurately assessing iron status. This is expensive, time consuming, and unpleasant for the patient. Recently the serum transferrin receptor assay has been developed, enabling more accurate assessment of iron status in this group of patients.
Serum ferritin, a 480 kDa multisubunit protein, represents the body's iron storage pool. A reduced serum ferritin concentration …